Management of alcoholic hepatitis: A clinical perspective

Abstract

Alcohol‐associated liver disease is the primary cause of liver‐related mortality worldwide and one of the most common indications for liver transplantation. Alcoholic hepatitis represents the most acute and severe manifestation of alcohol‐associated liver disease and is characterized by a rapid onset of jaundice with progressive inflammatory liver injury, worsening of portal hypertension, and an increased risk for multiorgan failure in patients with excessive alcohol consumption. Severe alcoholic hepatitis is associated with a poor prognosis and high short‐term mortality. During the COVID‐19 pandemic, rates of alcohol‐associated hepatitis have increased significantly, underscoring that it is a serious and growing health problem. However, adequate management of alcohol‐associated hepatitis and its complications in everyday clinical practice remains a major challenge. Currently, pharmacotherapy is limited to corticosteroids, although these have only a moderate effect on reducing short‐term mortality. In recent years, translational studies deciphering key mechanisms of disease development and progression have led to important advances in the understanding of the pathogenesis of alcoholic hepatitis. Emerging pathophysiology‐based therapeutic approaches include anti‐inflammatory agents, modifications of the gut‐liver axis and intestinal dysbiosis, epigenetic modulation, antioxidants, and drugs targeting liver regeneration. Concurrently, evidence is increasing that early liver transplantation is a safe treatment option with important survival benefits in selected patients with severe alcoholic hepatitis not responding to medical treatment. This narrative review describes current pathophysiology and management concepts of alcoholic hepatitis, provides an update on emerging treatment options, and focuses on the need for holistic and patient‐centred treatment approaches to improve prognosis.

Non-cirrhotic Ascites: A Case of Severe Alcoholic Hepatitis

“…Alcoholic hepatitis manifests as acute hepatic inflammation, posing significant morbidity and mortality risks, particularly in individuals with pre-existing steatosis or cirrhosis. Furthermore, AH has the potential to advance to alcohol-induced liver cirrhosis, lead through portal hypertension, involving major complications of hepatic encephalopathy, life-threatening variceal bleeding, and recurrent ascites [ 1 , 2 ].…”

“…It accounts for about four of every 100,000 hospital admissions in the United States. Severe cases of AH may present with jaundice, hepatic encephalopathy, coagulopathy, and ascites [ 2 ]. While underlying cirrhosis increases the likelihood of ascites development in AH, it is rarely seen in those without pre-existing advanced liver disease [ 3 ].…”

Water decoction of Pericarpium citri reticulatae and Amomi fructus ameliorates alcohol-induced liver disease involved in the modulation of gut microbiota and TLR4/NF-κB pathway

“…There is growing evidence that oxidative stress can activate fatty acid synthesis to trigger lipid droplet accumulation in the hepatocytes (Sun et al, 2020). Hepatocytes exposed to alcohol increase the NADH/ NAD + ratio, which can enhance lipid synthesis and prevent βoxidation of free fatty acids, leading to triglyceride accumulation in the liver (German et al, 2021;Kasper et al, 2023). Disturbance of the Frontiers in Pharmacology frontiersin.org 13 lipid metabolism will result in progression of hepatic steatosis, which is the early stage of alcoholic liver injury (Jeon and Carr, 2020).…”

Acute alcoholic hepatitis – the role of modern hepatoprotectors

“…В основе формирования АА повреждения печени лежат два механизма: первичный (посредством воздействия этанола на гепатоциты и спровоцированного им окислительного стресса) и вторичный (посредством изменений в оси кишечник-печень с дисбактериозом и повышения проницаемости стенки кишечника) [4,7].…”