From the Guidelines
Alcoholic hepatitis patients should immediately stop drinking alcohol and seek medical attention, with treatment typically including nutritional support, management of complications, and possibly medications like corticosteroids (prednisolone 40mg daily for 28 days) for severe cases, as recommended by the most recent guidelines 1. The condition develops because alcohol is toxic to liver cells, causing inflammation, fat accumulation, and eventually scarring. Some key points to consider in the management of alcoholic hepatitis include:
- Abstinence from alcohol is the most important intervention, as continued drinking significantly worsens liver damage and reduces survival chances 1.
- Corticosteroid therapy (prednisolone 40 mg/day or methylprednisolone 32 mg/day) is recommended in patients with a severe form of alcoholic hepatitis, as it improves short-term survival 1.
- The combination of N-acetylcysteine and corticosteroids can be offered to patients with a severe form of alcoholic hepatitis, although confirmatory studies are necessary before recommending this combination in a systematic way 1.
- Pentoxifylline should no longer be offered to patients with severe alcoholic hepatitis due to its ineffectiveness 1.
- Fast-track liver transplantation should be considered for patients at the end of their therapeutic options, with a rigorous and multidisciplinary selection process 1. Regular medical follow-up is necessary to monitor liver function and manage any complications, with a focus on maintaining abstinence and addressing nutritional deficiencies 1.
From the Research
Alcoholic Hepatitis Treatment Options
- Corticosteroids, such as prednisolone, are a common treatment for severe alcoholic hepatitis, with studies showing improved 1-month survival rates 2, 3, 4
- Pentoxifylline is also used to treat severe alcoholic hepatitis, but its efficacy compared to corticosteroids is still debated, with some studies showing no significant difference in survival rates 2, 5
- Combination therapy of pentoxifylline and prednisolone has been studied, but results show no significant improvement in 6-month survival rates compared to prednisolone alone 5
- Fecal microbiota transplantation (FMT) has been explored as a potential treatment for severe alcoholic hepatitis, with one study showing improved survival rates compared to other treatments 6
Prognosis and Survival Rates
- Severe alcoholic hepatitis is associated with high mortality rates, with 50% of patients dying within 2 months without treatment 3
- Corticosteroid therapy can improve 1-month survival rates to 80% 3, 4
- 6-month survival rates for patients with severe alcoholic hepatitis vary depending on treatment, with studies showing rates ranging from 64.5% to 72.9% 2, 5
- FMT has been shown to improve survival rates, with one study reporting a 75% survival rate at 1 and 3 months 6
Liver Transplantation
- Liver transplantation is considered a treatment option for patients with severe alcoholic hepatitis who do not respond to medical therapy 3, 4
- Early liver transplantation may be appropriate for highly select patients with severe alcoholic hepatitis 4
- The proportion of patients waiting for liver transplantation with alcohol-associated liver disease has increased in recent years, highlighting the need for effective treatment options 4