Acute alcoholic hepatitis: management in 2011

Abstract

Acute alcoholic hepatitis associates liver failure and jaundice in a context of chronic ethanol intoxication. It results from two mechanisms of ethanol-induced liver aggression: a dose-dependent toxicity and an inflammatory response. Diagnosis is based on clinical examination (assessing jaundice, fever, ascitis, malnutrition, hepatic encephalopathy, and/or tender liver) and laboratory tests (showing elevated aspartate aminotransferase > 2N with an aspartate aminotransferase-to-alanine aminotransferase ratio > 2, elevated white blood cell count, increased serum bilirubin, and/or increased international normalized ratio [INR]). Transvenous liver biopsy is useful to confirm the diagnosis. Several prognostic scores have been validated, including Maddrey, Glasgow, and MELD scores. Abstinence from ethanol is basically required. The current gold standard treatment includes corticosteroids. Pentoxifylline and enteral nutrition may be considered in case of uncontrolled infection. If refractoriness is assessed, salvage treatments remain to be defined.