Alcoholic hepatitis is a devastating form of acute liver injury seen in chronic alcohol abusers with significant morbidity and mortality. It is a multisystem disease that is precipitated by ingesting large quantities of alcohol with genetic and environmental factors playing a role. Prognostic criteria have been developed to predict disease severity and these criteria can serve as indicators to initiate medical
therapy. Primary
therapy remains abstinence and supportive care, as continued
alcohol abuse is the most important risk factor for
disease progression. The cornerstone of supportive care remains aggressive
nutritional support, and although acute
alcoholic hepatitis has been extensively studied, few specific medical
therapies have been successful.
Corticosteroids remain the most effective medical
therapy available in improving short term survival in a select group of patients with
alcoholic hepatitis; however, the long-term outcome of
drug therapies is still not entirely clear and further clinical investigation is necessary. While
liver transplantation for acute
alcoholic hepatitis have demonstrated promising results, this practice remains controversial and has not been advocated universally, with most transplant centers requiring a prolonged period of abstinence before considering
transplantation. Extracorporeal liver support devices, although still experimental, have been developed as a form of liver support to give additional time for liver regeneration. These have the potential for a significant therapeutic option in the future for this unfortunately dreadful disease.