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World J Hepatol. Dec 27, 2012; 4(12): 335-341
Published online Dec 27, 2012. doi: 10.4254/wjh.v4.i12.335
Management of alcoholic hepatitis: Current concepts
Hetal A Karsan, Samir Parekh
Hetal A Karsan, Atlanta Gastroenterology Associates, Emory University, Atlanta, GA 30342, United States
Hetal A Karsan, Samir Parekh, Emory University Liver Transplant Program, Atlanta, GA 30322, United States
Author contributions: Karsan HA designed the original outline; both Karsan HA and Parekh S wrote the paper.
Correspondence to: Hetal Karsan, MD, FACG, FACP, Clinical Assistant Professor of Medicine, Atlanta Gastroenterology Associates, Emory University, 5671 Peachtree-Dunwoody Road, Suite 600, Atlanta, GA 30342, United States.
Telephone: +1-404-2579000 Fax:+1-404-8479792
Received: October 25, 2011
Revised: July 23, 2012
Accepted: November 14, 2012
Published online: December 27, 2012

Alcoholic hepatitis is a devastating form of acute liver injury seen in chronic alcohol abusers with significant morbidity and mortality. It is a multisystem disease that is precipitated by ingesting large quantities of alcohol with genetic and environmental factors playing a role. Prognostic criteria have been developed to predict disease severity and these criteria can serve as indicators to initiate medical therapy. Primary therapy remains abstinence and supportive care, as continued alcohol abuse is the most important risk factor for disease progression. The cornerstone of supportive care remains aggressive nutritional support, and although acute alcoholic hepatitis has been extensively studied, few specific medical therapies have been successful. Corticosteroids remain the most effective medical therapy available in improving short term survival in a select group of patients with alcoholic hepatitis; however, the long-term outcome of drug therapies is still not entirely clear and further clinical investigation is necessary. While liver transplantation for acute alcoholic hepatitis have demonstrated promising results, this practice remains controversial and has not been advocated universally, with most transplant centers requiring a prolonged period of abstinence before considering transplantation. Extracorporeal liver support devices, although still experimental, have been developed as a form of liver support to give additional time for liver regeneration. These have the potential for a significant therapeutic option in the future for this unfortunately dreadful disease.

Keywords: Alcholic hepatitis, Acute liver injury, Abstinence, Nutrition, Corticosteroids, Transplantation, Extracorporeal liver support