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World J Gastroenterol. May 28, 2014; 20(20): 6279-6286
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6279
Alcoholic hepatitis: A comprehensive review of pathogenesis and treatment
Maneerat Chayanupatkul, Suthat Liangpunsakul
Maneerat Chayanupatkul, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, United States
Suthat Liangpunsakul, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, IN 46202, United States
Suthat Liangpunsakul, Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, United States
Author contributions: Chayanupatkul M reviewed the manuscript and revised this paper; Liangpunsakul S contributed to the concept, write, and edited the article.
Supported by K08 AA016570 from the NIH/NIAAA, 1I01CX000361-01 from the Veterans Affairs Research and Administration, Indiana University Research Support Fund Grant, and W81XWH-12-1-0497 from United States Department of Defense (all to Liangpunsakul S)
Correspondence to: Suthat Liangpunsakul, MD, MPH, Associate Professor of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, 550 N University Blvd, UH 4100, Indianapolis, IN 46202, United States. sliangpu@iupui.edu
Telephone: +1-317-2781630 Fax: +1-317-9883180
Received: November 12, 2013
Revised: December 31, 2013
Accepted: January 19, 2014
Published online: May 28, 2014
Processing time: 197 Days and 0.6 Hours
Abstract

Alcoholic hepatitis (AH) is an acute hepatic inflammation associated with significant morbidity and mortality. Current evidence suggests that the pathogenesis is the end result of the complex interplay between ethanol metabolism, inflammation and innate immunity. Several clinical scoring systems have been derived to predict the clinical outcomes of patients with AH; such as Child-Turcotte-Pugh score, the Maddrey discriminant function, the Lille Model, the model for end stage liver disease scores, and the Glasgow alcoholic hepatitis score. At present, Corticosteroids or pentoxifylline are the current pharmacologic treatment options; though the outcomes from the therapies are poor. Liver transplantation as the treatment of alcoholic hepatitis remains controversial, and in an era of organ shortage current guidelines do not recommend transplantation as the treatment option. Because of the limitations in the therapeutic options, it is no doubt that there is a critical need for the newer and more effective pharmacological agents to treat AH.

Keywords: Alcoholic hepatitis; Pathogenesis; Treatment; Model for end stage liver disease; Discriminant function; Lille Model; Glasgow alcoholic hepatitis score; Liver transplantation

Core tip: Alcoholic hepatitis (AH) is still a major problem in the United States due to significant morbidity and mortality. Currently, corticosteroids or pentoxifylline are the main pharmacological treatment options; though the outcomes from the therapies are poor. Because of the limitations in the therapeutic options, it is no doubt that there is a critical need for the newer and more effective pharmacological agents to treat AH.