Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 28, 2017; 9(12): 567-585
Published online Apr 28, 2017. doi: 10.4254/wjh.v9.i12.567
Emerging concepts in alcoholic hepatitis
Phoenix Fung, Nikolaos Pyrsopoulos
Phoenix Fung, Nikolaos Pyrsopoulos, Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Author contributions: Fung P reviewed the literature, performed the majority of writing, and prepared the figures and illustrations; Pyrsopoulos N designed, co-authored and revised the manuscript.
Conflict-of-interest statement: In regards to affiliations, Phoenix Fung and Nikolaos Pyrsopoulos perform research for Vital Therapies and Gilead Sciences. Nikolaos Pyrsopoulos is a member of the scientific advisory board for Vital Therapies and advisory board for Gilead.
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:
Correspondence to: Nikolaos Pyrsopoulos, MD, PhD, MBA, Associate Professor of Medicine, Chief of Gastroenterology and Hepatology, Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, United States.
Telephone: +1-973-9725252 Fax: +1-973-9723144
Received: December 5, 2016
Peer-review started: December 6, 2016
First decision: January 16, 2017
Revised: February 21, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: April 28, 2017

Severe alcoholic hepatitis is implicated as a costly, worldwide public health issue with high morbidity and mortality. The one-month survival for severe alcoholic hepatitis is low with mortality rates high as 30%-50%. Abstinence from alcohol is the recommended first-line treatment. Although corticosteroids remain as the current evidence based option for selected patients with discriminant function > 32, improvement of short-term survival rate may be the only benefit. Identification of individuals with risk factors for the development of severe alcoholic hepatitis may provide insight to the diverse clinical spectrum and prognosis of the disease. The understanding of the complex pathophysiologic processes of alcoholic hepatitis is the key to elucidating new therapeutic treatments. Newer research describes the use of gut microbiota modification, immune modulation, stimulation of liver regeneration, caspase inhibitors, farnesoid X receptors, and the extracorporeal liver assist device to aid in hepatocellular recovery. Liver transplantation can be considered as the last medical option for patients failing conventional medical interventions. Although the preliminary data is promising in patients with low risk of recividism, controversy remains due to organ scarcity. This review article comprehensively summarizes the epidemiology, pathophysiology, risk factors, and prognostic indicators of severe alcoholic hepatitis with a focus on the current and emerging therapeutics.

Keywords: Immune modulation, Alcoholic hepatitis, Gut microbiota modification, Extracorporeal liver assist device, Apoptosis inhibitors

Core tip: Current research of alcoholic hepatitis pathophysiology via translational research has provided insight to novel therapeutic options. Recovery from severe alcoholic hepatitis with assistance of gut microbiota modification, immune modulators, stimulation of liver regeneration, caspase inhibitors, farnesoid X receptors, and extracorporeal liver assist device may be promising.