From the Guidelines
The treatment for alcoholic hepatitis primarily involves complete abstinence from alcohol, which is the most important intervention, as supported by the most recent and highest quality study 1. For mild cases, supportive care including adequate nutrition, vitamin supplementation (particularly B vitamins like thiamine), and management of complications may be sufficient. In severe alcoholic hepatitis, corticosteroids such as prednisolone (40mg daily for 28 days followed by a taper) are often prescribed to reduce inflammation, as recommended by recent guidelines 1. Pentoxifylline is no longer recommended as an alternative due to its ineffectiveness, as stated in the latest guidelines 1. Nutritional support is crucial, with a high-calorie, high-protein diet recommended unless contraindicated by hepatic encephalopathy. Patients should also receive folate (1mg daily), thiamine (100mg daily), and multivitamins to address common deficiencies. Management of complications like ascites, hepatic encephalopathy, and bleeding varices is essential. For long-term recovery, patients need addiction counseling and support for alcohol cessation. Some key points to consider in the treatment of alcoholic hepatitis include:
- Assessing disease severity using prognostic scores such as the Maddrey discriminant function (MDF) or the Model for End-Stage Liver Disease (MELD) score 1.
- Using the Lille score to assess treatment response at day 7 and guide further management 1.
- Considering early liver transplantation in highly selected patients with severe alcoholic hepatitis who do not respond to medical treatment 1.
- Providing ongoing support and encouragement for patients to maintain abstinence from alcohol, as this is critical for improving survival and preventing further liver damage 1.
From the Research
Treatment Options for Alcohol Hepatitis
The treatment for alcohol hepatitis involves a combination of supportive care, pharmacologic therapy, and in some cases, liver transplantation.
- Supportive care includes abstinence from alcohol and nutritional supplementation to manage malnutrition and support liver function 2, 3.
- Pharmacologic therapy with corticosteroids, such as prednisolone, has been shown to improve short-term survival in patients with severe alcoholic hepatitis 4, 2, 5, 3.
- Pentoxifylline, another pharmacologic agent, has not been found to improve survival in patients with alcoholic hepatitis 4, 2, 5.
Liver Transplantation
Liver transplantation is a controversial treatment option for alcoholic hepatitis, with most transplant centers requiring a period of abstinence before considering transplantation 6, 5, 3.
- However, some studies have shown promising results with liver transplantation in patients with severe alcoholic hepatitis who do not respond to pharmacologic therapy 6.
- The use of liver transplantation in alcoholic hepatitis is still being debated, and further studies are needed to determine its effectiveness and to develop guidelines for patient selection and post-transplant management 2, 6.
Emerging Therapies
Several new and repurposed compounds are being investigated for the treatment of severe alcoholic hepatitis, targeting various pathways in the pathogenesis of the disease, including the gut-liver axis, inflammatory cascade, and liver injury 2.
- These emerging therapies hold promise for improving treatment outcomes in patients with alcoholic hepatitis, but further research is needed to determine their safety and efficacy 2.