[Alcoholic steatohepatitis: what's new in 2012?]

Area of Science:

• Hepatology
• Gastroenterology
• Internal Medicine

Context:

• Alcoholic liver disease (ALD) encompasses a range of hepatic lesions, with alcoholic steatohepatitis (ASH) representing the most severe manifestation.
• European guidelines define alcoholic hepatitis as a clinical syndrome characterized by recent jaundice and/or ascites in individuals with ongoing alcohol misuse.
• ASH is a leading cause of liver disease, second only to infection.

Purpose:

• To outline the diagnostic criteria and therapeutic strategies for alcoholic steatohepatitis (ASH).
• To emphasize the importance of prognostic scores and liver biopsy in diagnosing severe ASH.
• To detail the treatment protocols for non-severe and severe forms of ASH, including the role of specific medications and response assessment.

Summary:

• Alcoholic steatohepatitis (ASH) diagnosis requires histological confirmation, especially for severe cases identified by prognostic scores.
• Non-severe ASH may resolve with alcohol cessation alone.
• Severe ASH management involves corticosteroids and N-acetylcysteine, with pentoxifylline considered for uncontrolled infections. The Lille score assesses treatment response at day 7.

Impact:

• Provides a clear diagnostic and management pathway for clinicians dealing with alcoholic liver disease.
• Highlights the improved survival rates for severe ASH patients undergoing specific medical interventions.
• Establishes the Lille score as a critical tool for tailoring treatment duration and optimizing patient outcomes.