Prognosis of treated severe alcoholic hepatitis in patients with gastrointestinal bleeding

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

“…Patients with gastrointestinal bleeding (GIB) have similarly been excluded in many clinical trials in AH. In a retrospective study of 105 patients with biopsy‐proven AH, 55% presented with GIB and the remainder did not . Both groups were given prednisolone, and GIB patients started at a mean of 5 days after the bleeding episode (mostly variceal hemorrhage).…”

“…In a retrospective study of 105 patients with biopsy-proven AH, 55% presented with GIB and the remainder did not. (173) Both groups were given prednisolone, and GIB patients started at a mean of 5 days after the bleeding episode (mostly variceal hemorrhage). GIB patients had a lower incidence of infections likely due to prophylactic antibiotics, but there were no differences in survival at 1, 3, and 6 months between the two groups.…”

Treatment of Alcoholic Liver Disease Including Emerging Therapies, Novel Targets, and Liver Transplantation

“…This was attributable to antibiotic therapy mandated in patients with acute GI bleed and could have improved survival in GI bleeders in the study. If validated in prospective trials, this data indicate that GI bleed does not worsen survival in AH patients treated with corticosteroids [ 92 ].…”

“…Rudler et al [ 92 ] conducted a retrospective analysis of survival among patients with severe AH who presented to a hospital with upper GI bleed and compared them with patients with severe AH without GI bleeding. A total of 48 patients with upper GI bleed and 47 patients without GI bleed were analyzed.…”

Microvesicles in hepatic and peripheral vein can predict nonresponse to corticosteroid therapy in severe alcoholic hepatitis

“…Almost 40% of patients with SAH are classified as nonresponders to corticosteroids, which is associated with a 6‐month survival as low as 25% and dictates discontinuation of prednisolone owing to lack of therapeutic benefit . However, this means that assessment requires at least 7 days of high‐dose corticosteroids, and nonresponse to corticosteroids is highly predictive of sepsis . Thus, there is a need for improved non‐invasive tools, which can reliably predict response before initiation of steroid therapy.…”