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2017 ; 9
(12
): 567-585
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Emerging concepts in alcoholic hepatitis
#MMPMID28515843
Fung P
; Pyrsopoulos N
World J Hepatol
2017[Apr]; 9
(12
): 567-585
PMID28515843
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Severe alcoholic hepatitis is implicated as a costly, worldwide public health
issue with high morbidity and mortality. The one-month survival for severe
alcoholic hepatitis is low with mortality rates high as 30%-50%. Abstinence from
alcohol is the recommended first-line treatment. Although corticosteroids remain
as the current evidence based option for selected patients with discriminant
function > 32, improvement of short-term survival rate may be the only benefit.
Identification of individuals with risk factors for the development of severe
alcoholic hepatitis may provide insight to the diverse clinical spectrum and
prognosis of the disease. The understanding of the complex pathophysiologic
processes of alcoholic hepatitis is the key to elucidating new therapeutic
treatments. Newer research describes the use of gut microbiota modification,
immune modulation, stimulation of liver regeneration, caspase inhibitors,
farnesoid X receptors, and the extracorporeal liver assist device to aid in
hepatocellular recovery. Liver transplantation can be considered as the last
medical option for patients failing conventional medical interventions. Although
the preliminary data is promising in patients with low risk of recividism,
controversy remains due to organ scarcity. This review article comprehensively
summarizes the epidemiology, pathophysiology, risk factors, and prognostic
indicators of severe alcoholic hepatitis with a focus on the current and emerging
therapeutics.
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