Alcoholic hepatitis is a common disease with an overall 1-year mortality of 20%. Although the classical treatment for
alcoholic hepatitis is abstinence, in some individuals abstinence alone is inadequate to promote survival and recovery. This is particularly true of patients with severe
alcoholic hepatitis, who are identified by
jaundice, coagulopathy and neutrophilia. Within the last two decades, several agents have been examined as treatments for
alcoholic hepatitis and
cirrhosis. They have targeted several key processes in the pathophysiology of
alcoholic liver disease, including hypermetabolism,
inflammation,
cytokine dysregulation and
oxidant stress. The compounds that offer the greatest survival benefit to patients with severe
alcoholic hepatitis are
corticosteroids. Several groups have reported excellent results with
corticosteroids, but positive results are not uniform, and there remains some controversy over their efficacy. Even if
corticosteroids are beneficial for
alcoholic hepatitis, they are not recommended for all patients at risk. Consequently, other agents are being tested that have broader applicability to individuals with
contraindications to
steroids. In this regard,
pentoxifylline shows some promise, as does
enteral feeding with medium chain
triglycerides. Independent efforts are also being directed toward treatment of chronic
alcoholic liver disease and
alcoholic cirrhosis.
Anti-oxidants have received the greatest attention; drugs such as S-adenosyl-
methionine may be of benefit. This and others are under active study.