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Severe alcoholic hepatitis: current perspectives.

Cyriac Abby Philips1, Philip Augustine2, Praveen Kumar Yerol3

  • 1The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India.

Hepatic Medicine : Evidence and Research
|September 10, 2019
PubMed
Summary
This summary is machine-generated.

Severe alcoholic hepatitis (AH) has high mortality. Current treatments like corticosteroids offer no long-term survival benefit, necessitating research into novel therapies such as liver transplantation and fecal microbiota transplantation for severe alcoholic hepatitis.

Keywords:
ACLFSAHalcoholgut microbiomehepatitisstool transplant

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Severe acute alcoholic hepatitis (AH) is a critical condition in alcoholic liver disease, characterized by high short-term mortality.
  • It often presents as acute-on-chronic liver failure, with infections and advanced liver disease severity worsening prognosis.
  • Clinical presentation includes recent heavy alcohol use, jaundice, elevated liver enzymes, coagulopathy, hepatic encephalopathy, and potential sepsis leading to organ failure.

Purpose of the Study:

  • To provide an exhaustive review of severe alcoholic hepatitis.
  • To discuss definitions, disease severity, histopathology, and current and future treatment options.
  • To highlight the limitations of existing treatments and the need for novel therapeutic strategies.

Main Methods:

  • Comprehensive literature review of severe alcoholic hepatitis.
  • Analysis of existing clinical data on disease severity and treatment response indicators.
  • Evaluation of current and emerging treatment modalities, including corticosteroids, liver transplantation, growth factor therapy, and fecal microbiota transplantation.

Main Results:

  • Severe AH is associated with very high 180-day mortality, particularly when complicated by infections or advanced liver disease.
  • Corticosteroids are the only recommended treatment but lack long-term survival benefits.
  • Emerging therapies like liver transplantation, growth factor therapy, and fecal microbiota transplantation show promise but require further high-quality multi-center studies.

Conclusions:

  • Severe alcoholic hepatitis remains a life-threatening condition with limited effective long-term treatment options.
  • Current management relies on corticosteroids, which do not improve long-term survival.
  • Further research and high-quality multi-center trials are crucial for developing and validating novel, efficacious treatments for severe AH, including liver transplantation and microbiota-based therapies.