Acute alcoholic hepatitis.
Acute alcoholic hepatitis (AAH) is a frequent inflammatory liver disease with high short-term mortality rate. In this review, relationships between alcohol abuse and the epidemiology and the outcomes of AAH are discussed, as well as AAH pathogenesis. The role of endotoxins, tumor necrosis factor alpha, fibroblasts, and immune response to altered hepatocyte proteins is discussed. The need of a careful prognosis, supported by the use of Maddrey score, by the model for end-stage liver disease [Mayo end-stage liver disease (MELD)] score or by the Glasgow alcoholic hepatitis score, is outlined, as the use of the most effective drugs (glucocorticoids and anti-tumor necrosis factor alpha infliximab) is recommended only in severe AAH cases. The problems of liver transplant in severe AAH, and the need of a 6-month alcohol abstinence before transplant, are discussed, as well as the need of a careful psychologic assessment before the transplant.
Ceccanti
Mauro
M
Alcohol Liver Disease Unit, University "La Sapienza", Roma, Italy. mauro.ceccanti@uniroma1.it
Attili
Adolfo
A
Balducci
Giuseppe
G
Attilia
Fabio
F
Giacomelli
Stefano
S
Rotondo
Claudia
C
Sasso
Guido Francesco
GF
Xirouchakis
Elias
E
Attilia
Maria Luisa
ML
D000208:Acute Disease; D000818:Animals; D000431:Ethanol / Q000378:metabolism; D006519:Hepatitis, Alcoholic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D022781:Hepatocytes / Q000737:chemistry; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D008070:Lipopolysaccharides; D016031:Liver Transplantation; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D000431:Ethanol