Korean J Gastroenterol.  2015 Jan;65(1):4-11. 10.4166/kjg.2015.65.1.4.

Diagnostic and Therapeutic Strategies for Severe Alcoholic Hepatitis

• Kim W

• KMID: 2373174
• DOI: http://doi.org/10.4166/kjg.2015.65.1.4

Abstract

Alcoholic hepatitis (AH) is defined as an acute hepatic manifestation resulting from heavy alcohol intake. Histologically, alcoholic steatohepatitis (ASH) is characterized by hepatocellular steatosis, inflammation, and fibrosis. Alcohol abstinence is the sine qua non of therapy for AH and, in the milder forms, is prerequisite to clinical recovery. Severe ASH may lead to multi-organ failure such as acute kidney injury and infection, which has a major impact on survival and thus should be closely monitored. Patients with severe ASH have a drastic short-term mortality of up to 40-50%. Specific therapies should be considered for patients with severe ASH at risk of early death. Corticosteroids are the standard of care for patients with severe ASH. When corticosteroids are contraindicated, pentoxifylline may be an alternative option. Steroid responsiveness should be evaluated on the basis of Lille score. Tactically, we should explore novel therapeutic targets to suppress inflammation based on cytokine profiles, promote hepatic regeneration, limit innate immune responses, and restore altered gut mucosal integrity in severe ASH.

Keyword

Alcoholic steatohepatitis; Infection; Renal insufficiency; Corticosteroids; Pentoxifylline

MeSH Terms

Adrenal Cortex Hormones/therapeutic use
Free Radical Scavengers/therapeutic use
Hepatitis, Alcoholic/*diagnosis/drug therapy/pathology
Humans
Liver Transplantation
Pentoxifylline/therapeutic use
Prognosis
Severity of Illness Index
Adrenal Cortex Hormones
Free Radical Scavengers
Pentoxifylline

Reference

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