Topic Highlight
Copyright copy;2010 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2010; 16(39): 4905-4912
Published online Oct 21, 2010. doi: 10.3748/wjg.v16.i39.4905
Alcoholic hepatitis 2010: A clinician’s guide to diagnosis and therapy
Maziyar Amini, Bruce A Runyon
Maziyar Amini, Bruce A Runyon, Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
Author contributions: Amini M and Runyon BA contributed equally to this paper.
Correspondence to: Bruce A Runyon, MD, Director of Hepatology, Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, 11234 Anderson Street, #1556, Loma Linda, CA 92354, United States.
Telephone: +1-909-5584905 Fax: +1-909-5580274
Received: May 19, 2010
Revised: August 11, 2010
Accepted: August 18, 2010
Published online: October 21, 2010

Alcoholic hepatitis (AH) remains a common and life threatening cause of liver failure, especially when it is severe. Although the adjective “acute” is frequently used to describe this form of liver injury, it is usually subacute and has been developing for weeks to months before it becomes clinically apparent. Patients with this form of alcoholic liver disease usually have a history of drinking heavily for many years. While certain aspects of therapy, mainly nutritional support and abstinence are well established, significant debate has surrounded the pharmacologic treatment of AH, and many institutions practice widely varying treatment protocols. In recent years a significant amount of literature has helped focus on the details of treatment, and more data have accumulated regarding risks and benefits of pharmacologic treatment. In particular, the efficacy of pentoxifylline has become increasingly apparent, and when compared with the risks associated with prednisolone, has brought this drug to the forefront of therapy for severe AH. This review will focus on the clinical and laboratory diagnosis and pharmacologic therapies that should be applied during hospitalization and continued into outpatient management. We conclude that the routine use of glucocorticoids for severe AH poses significant risk with equivocal benefit, and that pentoxifylline is a better, safer and cheaper alternative. While the full details of nutritional support lie beyond the scope of this article, nutrition is a cornerstone of therapy and must be addressed in every patient diagnosed with AH. Finally, while traditional psychosocial techniques play a major role in post-hospitalization care of alcoholics, we hope to make the medical clinician realize his or her role in reducing recidivism rates with early and frequent outpatient visits and with the use of baclofen to reduce alcohol craving.

Keywords: Alcoholic hepatitis, Alcoholic liver disease, Pentoxifylline, Baclofen