Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.7825
Revised: August 28, 2013
Accepted: September 15, 2013
Published online: November 28, 2013
Processing time: 165 Days and 21.2 Hours
Acute alcoholic hepatitis (AAH) is characterised by deep jaundice in patients with a history of heavy alcohol use, which can progress to liver failure. A clinical diagnosis of AAH can be challenging to make in patients without a clear alcohol history or in the presence of risk factors for other causes of acute liver failure. Other causes of acute on chronic liver failure such as sepsis or variceal haemorrhage should be considered. Liver biopsy remains the only reliable method to make an accurate diagnosis. However, there is controversy surrounding the use of liver biopsy in patients with AAH because of the risks of performing a percutaneous biopsy and limitations in access to transjugular biopsy. We review the existing literature and find there are few studies directly comparing clinical and histological diagnosis of AAH. In the small number of studies that have been conducted the correlation between a clinical and histological diagnosis of AAH is poor. Due to this lack of agreement together with difficulties in accessing transjugular liver biopsy outside tertiary referral centres and research institutions, we cannot advocate universal biopsy for AAH but there remains a definite role for liver biopsy where there is clinical diagnostic doubt or dual pathology. It also adds value in a clinical trial context to ensure a homogeneous trial population and to further our understanding of the disease pathology. Further prospective studies are required to determine whether non-invasive markers can be used to accurately diagnose AAH.
Core tip: Acute alcoholic hepatitis (AAH) is a clinical syndrome of jaundice and coagulopathy in a patient with a recent history of heavy alcohol consumption. Clinical diagnosis is challenging and transjugular liver biopsy remains the gold standard. Here we discuss the literature which demonstrates there is a lack of agreement between clinical and histological diagnosis. This, together with limited availability of transjugular liver biopsy makes it impossible to advocate universal biopsy in all suspected cases of AAH. We suggest further research is conducted to prospectively compare histological and clinical parameters and to develop a reliable and accurate non-invasive diagnostic tool.