New treatment options for alcoholic hepatitis

Abstract

The burden of alcoholic liver disease has rapidly grown in the past two decades and is expected to increase further in the coming years. Alcoholic hepatitis, the most florid presentation of alcoholic liver disease, continues to have high morbidity and mortality, with significant financial and healthcare burden with limited treatment options. Steroids remain the current standard of care in severe alcoholic hepatitis in carefully selected patients. No specific treatments are available for those patients who are steroid ineligible, intolerant or unresponsive. Liver transplant has shown good short-term outcome; however, feasibility, ethical and economic concerns remain. Modification of gut microbiota composition and their products, such as lipopolysaccharide, nutritional interventions, immune modulation, increasing steroid sensitivity, genetic polymorphism and epigenetic modification of alcohol induced liver damage, augmenting hepatic regeneration using GCSF are potential therapeutic avenues in steroid non-responsive/ineligible patients. With better understanding of the pathophysiology, using “Omics” platforms, newer options for patients with alcoholic hepatitis are expected soon.

Keywords: Alcoholic liver disease; Alcoholic steatosis; Alcoholic hepatitis; Gut microbiota; Lipopolysaccharide; Steroid non-response

Core tip: With better treatment options available for other liver diseases like viral hepatitis the proportion of alcoholic liver disease is on the rise. Alcoholic hepatitis is the most serious presentation of alcoholic liver disease with significant morbidity, mortality and health care burden. Treatment options in steroid non-responders and steroid ineligible patients of severe alcoholic hepatitis are limited. Newer treatment options for these patients are the need of the hour. The molecular and cellular targets have been discussed.