Alcoholic hepatitis

Alcoholic hepatitis should be suspected in patients with a recent onset of jaundice and with excessive chronic alcohol consumption. Diagnosis is based on clinical presentation and typical laboratory findings (aspartate aminotransférase (AST)/alanine aminotransférase (ALT) ratio >1.5, AST >50 UI/L, AST and ALT <300 IU/L, total serum bilirubin >3 mg/dL). A liver biopsy is useful to confirm the diagnosis and exclude other diagnoses. Different prognosis tools aiming to estimate the risk of short-time mortality and to determine whether the patients should be treated with a specific therapy have been developed. The most used in clinical practice are the Maddrey discriminant function and the model for end-stage liver disease. Every patient has to be treated for alcohol dependence, regardless of severity, and receive adequate energy and protein intake. Corticosteroids given orally for 28 days represent the only treatment that has demonstrated a survival benefit in the short term. Unfortunately, approximately 40% of corticosteroid-treated severe alcoholic hepatitis patients do not improve liver function under therapy and are characterized by a very poor prognosis at 6 months (20%–30% chance of survival). Early liver transplantation is an efficient therapeutic option in carefully selected patients nonresponders to corticosteroid therapy, with an acceptable alcohol relapse rate. New therapies are currently in clinical evaluation and are urgently needed.