Alcoholic steatohepatitis.
Severe alcoholic steatohepatitis has a poor prognosis and is characterized by jaundice and signs of liver failure. Its incidence is unknown, but prevalence is around 20% in cohorts of alcoholics undergoing liver biopsy. Diagnosis is established with elevated liver transaminases, neutrophil counts, serum bilirubin, and impaired coagulation and a history of excessive alcohol consumption, and exclusion of other etiologies. Histology is helpful but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, and the Glasgow Alcoholic Hepatitis Score. Pathophysiology involves hepatic fat storage, increased hepatic uptake of gut-derived endotoxins triggering Kupffer cell activation and release of proinflammatory triggers, induction of cytochrome P4502E1 producing toxic acetaldehyde and reactive oxygen species, and ethanol-mediated hyperhomocysteinemia causing endoplasmic reticulum stress. Treatment includes abstinence, enteral nutrition, corticosteroids, and possibly pentoxifylline. A debate is ongoing whether certain patients with severe alcoholic steatohepatitis could be eligible for liver transplantation.
Stickel
Felix
F
Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Murtenstrasse 35, CH-3010 Bern, Switzerland. felix.stickel@ikp.unibe.ch
Seitz
Helmut K
HK
D019392:Cytochrome P-450 CYP2E1 / Q000502:physiology; D004750:Enteral Nutrition; D005235:Fatty Liver, Alcoholic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D006305:Health Status Indicators; D006801:Humans; D015227:Lipid Peroxidation; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D019392:Cytochrome P-450 CYP2E1