Alcoholic Hepatitis

Abstract

Alcoholic hepatitis (AH) is a common disease associated with significant morbidity and mortality. Most often the diagnosis is suggested by a history of heavy alcohol excess in a patient with features of hepatic decompensation. In its purest form, AH is a histologic diagnosis of acute hepatic inflammation in response to alcohol. The primary objective of treatment for AH is to support long-term alcohol abstinence and to achieve adequate nutrition with lifestyle modification; goal setting and education are integral to long-term medical management. Severity at presentation (calculated by way of the Maddrey score) determines outcome. Patients with AH represent a heterogeneous group with regard to severity and pathogenesis, with various therapeutic interventions assessed in patients with severe AH. To date, corticosteroids have been studied most, and despite remaining controversial, warrant a place in the treatment of selected patients. Recent advances in unraveling the aspects of disease pathogenesis in AH have raised the possibility of targeted therapies, such as anti-tumor necrosis factor-a monoclonals and pentoxifylline. Orthotopic liver transplantation is not recommended for patients with severe acute AH, as most have an unclear long-term prognosis in the context of ongoing excess alcohol ingestion at presentation.

Pentoxifylline versus prednisolone for severe alcoholic hepatitis: A randomized controlled trial

“…Although prednisolone is used widely and considered the standard treatment for severe acute alcoholic hepatitis with DF score ≥ 32, it is not free of adverse effects and has had its share of controversies [14] . Recently, pentoxifylline, a non-specific phosphodiesterase inhibitor, with combined anti-inflammatory (TNF-α inhibition) and antifibrogenic properties, has been found to be useful in patients with acute alcoholic hepatitis with DF ≥ 32 [15][16][17] . The beneficial effects are believed to occur through various mechanisms such as inhibition of phosphodiesterases, increased cAMP levels and downregulation of TNF-α, IL-1, IL-6, transforming growth factor-beta (TGF-β), interferon-gamma (IFN-γ), stellate cell activation and procollagen-Ⅰ mRNA expression [18] .…”

Transient acute liver failure complicating transurethral resection syndrome

“…Acute alcoholic intoxication can also result in alcoholic hepatitis, which is most likely to occur in subjects with chronic alcohol abuse and/or patients affected by alcoholic cirrhosis. In these cases, the diagnosis is suggested by a history of alcohol abuse in patients with features of hepatic decompensation [9]. By contrast, in the present patient the basal evaluation of liver parameters and his clinical history argue against chronic alcohol abuse, and for this reason it appears unlikely that alcohol alone induced the present clinical picture.…”

Role of Pentoxifylline in Severe Alcoholic Hepatitis

“…Recently Pentoxifylline a non-specific phosphodiesterase inhibitor, with combined antiinflammatory and antifibrogenic properties found to be effective in patients with alcoholic hepatitis with DF>32. (10,11) Pentoxifylline (PTX) has been reported to be effective in inhibiting tumor necrosis factor (TNF-alfa) production by mononuclear cells. (12,13) The beneficial effects are believed to occur through various mechanism such as inhibition of phosphodiesterases, increased cAMP levels and down regulation of TNF-alfa,IL-1,IL-6,transforming growth factor beta (TGF-beta),interferon gamma ,stellate cell activation and procollagen-1 mRNA expression.…”