Abstract and Introduction
Abstract
Alcoholic hepatitis is a distinct clinical syndrome among people with chronic and active alcohol abuse, with a potential for 30%–40% mortality at 1 month among those with severe disease. Corticosteroids or pentoxifylline are the current pharmacologic treatment options, but they provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) ≥32 or Model for End-Stage Liver Disease score ≥18. The Lille score is used to determine response to steroids. Currently, a minimum of 6 months of abstinence from alcohol use is required for patients to receive a liver transplant, a requirement that cannot be met by patients with severe alcoholic hepatitis nonresponsive to steroids (Lille score ≥0.45). Data are emerging on the benefit of liver transplantation in select patients with first episode of severe alcoholic hepatitis. This review also focuses on recent treatment trials in alcoholic hepatitis including liver transplantation and its associated controversies, as well as possible future targets and pharmacologic treatment options for patients with alcoholic hepatitis that are being pursued through upcoming consortium studies.
Introduction
Alcoholic cirrhosis is the eighth most common cause of mortality in the United States and the second leading cause of mortality among all gastrointestinal diseases.[1] This may come as no surprise because the majority of the U.S. population consumes alcohol, with 1 in 10 reporting "heavy" drinking (≥3 drinks/day).[2] Fortunately, only a minority of these heavy drinkers develop significant liver disease.[2,3,4] The reasons for this are unclear, although demographic and genetic factors such as gender, ethnicity, binge drinking (5 or more drinks at a time), nutrition status including obesity, coexisting liver diseases such as hepatitis C virus (HCV) infection, and patatin-like phospholipase-3 gene polymorphism clearly play a role.[2,5–8] A recent study by Becker et al[4] indicates that younger people, women, and binge drinkers are more prone to develop alcoholic hepatitis (AH). This clinical decision meeting should take these factors into account, rather than focusing only on a precise level of alcohol consumption. AH is a clinical syndrome among subjects with chronic and active alcohol abuse characterized clinically by hepatic decompensation and portal hypertension.[9,10] Owing to the high mortality associated with this condition as well as the lack of adequate pharmacologic treatments, increasing efforts have been directed toward developing new therapies.[11] This review focuses on the challenges related to management of AH as well as future directions in the field.
Clin Gastroenterol Hepatol. 2014;12(4):555-564. © 2014 AGA Institute
