From the Guidelines
The treatment for alcoholic hepatitis primarily involves complete abstinence from alcohol, and for severe cases, corticosteroids like prednisolone (40mg daily for 28 days) are recommended for patients without contraindications such as active infection or gastrointestinal bleeding, as supported by recent guidelines 1.
Key Considerations
- The most important intervention is complete abstinence from alcohol.
- For mild cases, supportive care with nutritional support and abstinence may be sufficient.
- In severe alcoholic hepatitis, corticosteroids are the mainstay of treatment.
- Pentoxifylline is no longer recommended due to its ineffectiveness, as stated in recent guidelines 1.
- Nutritional therapy is crucial, with a recommended protein intake of 1.2-1.5g/kg/day and total caloric intake of 35-40 kcal/kg/day.
- Vitamin supplementation, particularly thiamine (100mg daily), folate, and multivitamins, helps address common deficiencies.
- Management of complications like ascites, hepatic encephalopathy, and infections is essential.
- Patients should be evaluated for liver transplantation if they demonstrate a commitment to sobriety.
Evaluation and Treatment Approach
- The Maddrey Discriminant Function and the MELD score are recommended for identifying severe forms of alcoholic hepatitis 1.
- The Lille score must be calculated on the seventh day of treatment to identify patients not responding to treatment 1.
- Combining the Lille and MELD scores is the optimal approach for evaluating short- and medium-term risk of death 1.
- Fast-track liver transplantation must be considered for patients at the end of their therapeutic options, with a rigorous and multidisciplinary selection process 1.
From the Research
Definition of Alcohol Hepatitis
Alcohol hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use 2.
Treatment of Alcohol Hepatitis
The treatment for alcohol hepatitis includes:
- Supportive therapy for abstinence and nutritional supplementation for those patients with markedly reduced caloric intake 3
- Corticosteroids, such as prednisolone, which have been shown to improve short-term survival in severe alcoholic hepatitis 4, 2
- Pentoxifylline, which has been studied as an alternative to corticosteroids, but its efficacy is not statistically equivalent to that of prednisolone 4, 5
- Combination therapy, such as anakinra, pentoxifylline, and zinc, which has been shown to provide similar survival benefits compared to corticosteroid therapy in severe alcohol-associated hepatitis 6
Key Findings
- The use of prednisolone is associated with a reduction in 28-day mortality, but this reduction does not reach significance, and there is no improvement in outcomes at 90 days or 1 year 2
- Pentoxifylline does not improve survival in patients with alcoholic hepatitis 2
- The combination of pentoxifylline and prednisolone yields no additional benefit in terms of mortality and morbidity compared to pentoxifylline monotherapy 5
- Liver transplantation could be an important salvage option for a highly select group of patients with alcoholic hepatitis 3