Alcoholic steatohepatitis: management and prognosis

Alcoholic hepatitis is a disease with a wide range of severity. Patients with severe disease have short-term mortality rates above 35%. In these high-risk patients, pharmacologic therapy is an important adjunct to supportive medical care and has been proved to improve survival. Given the benefit of drug treatment, it is important to identify patients at risk of early mortality from alcoholic hepatitis. A number of validated scoring systems are useful for this purpose, including the Maddrey Discriminant Function, the Model of End-Stage Liver Disease score, and the Glasgow Alcoholic Hepatitis score. Patients judged by one or more of these criteria to have severe alcoholic hepatitis should be treated with corticosteroids or pentoxifylline, provided they have no contraindications for this treatment. Adequate nutrition is also critical and should be provided by tube feeding if necessary. A prompt decline in serum bilirubin indicates a favorable response to therapy. Patients who do not exhibit a reduction in serum bilirubin within 1 week are considered nonresponders and have a 6-month mortality rate of 50% or higher.