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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 11893-11903
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.11893
Advances in alcoholic liver disease: An update on alcoholic hepatitis
Randy Liang, Andy Liu, Ryan B Perumpail, Robert J Wong, Aijaz Ahmed
Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States
Andy Liu, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Ryan B Perumpail, Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States
Robert J Wong, Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, Oakland, CA 94602, United States
Author contributions: Liang R, Liu A, Perumpail RB, Wong RJ and Ahmed A designed research; Liang R, Liu A, Perumpail RB, Wong RJ and Ahmed A performed research; Liang R, Liu A, Perumpail RB, Wong RJ and Ahmed A contributed new reagents or analytic tools; Liang R, Liu A, Perumpail RB, Wong RJ and Ahmed A analyzed data; Liang R wrote the paper.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aijaz Ahmed, MD, Associate Professor, Medical Director, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94305, United States. aijazahmed@stanford.edu
Telephone: +1-650-4986091 Fax: +1-650-4985692
Received: May 26, 2015
Peer-review started: May 27, 2015
First decision: June 23, 2015
Revised: July 8, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Processing time: 169 Days and 6.4 Hours
Abstract

Alcoholic hepatitis is a pro-inflammatory chronic liver disease that is associated with high short-term morbidity and mortality (25%-35% in one month) in the setting of chronic alcohol use. Histopathology is notable for micro- and macrovesicular steatosis, acute inflammation with neutrophil infiltration, hepatocellular necrosis, perivenular and perisinusoidal fibrosis, and Mallory hyaline bodies found in ballooned hepatocytes. Other findings include the characteristic eosinophilic fibrillar material (Mallory’s hyaline bodies) found in ballooned hepatocytes. The presence of focal intense lobular infiltration of neutrophils is what typically distinguishes alcoholic hepatitis from other forms of hepatitis, in which the inflammatory infiltrate is primarily composed of mononuclear cells. Management consists of a multidisciplinary approach including alcohol cessation, fluid and electrolyte correction, treatment of alcohol withdrawal, and pharmacological therapy based on the severity of the disease. Pharmacological treatment for severe alcoholic hepatitis, as defined by Maddrey’s discriminant factor ≥ 32, consists of either prednisolone or pentoxifylline for a period of four weeks. The body of evidence for corticosteroids has been greater than pentoxifylline, although there are higher risks of complications. Recently head-to-head trials between corticosteroids and pentoxifylline have been performed, which again suggests that corticosteroids should strongly be considered over pentoxifylline.

Keywords: Alcoholic Hepatitis; Maddrey discriminant function; Corticosteroids; Pentoxifylline; Alcoholic liver disease

Core tip: Alcoholic hepatitis is a pro-inflammatory chronic liver disease that is associated with high short-term morbidity and mortality in the setting of chronic alcohol use. Management consists of a multidisciplinary approach including alcohol cessation, fluid and electrolyte correction, treatment of alcohol withdrawal, and pharmacological therapy based on the severity of the disease. Pharmacological treatment for severe alcoholic hepatitis, as defined by Maddrey’s discriminant function ≥ 32, consists of either prednisolone or pentoxifylline for a period of four weeks. The body of evidence in favor of corticosteroids has been greater than pentoxifylline, although there are higher risks of complications.