title: [Diagnostic and therapeutic strategies for severe alcoholic hepatitis].
abstract: Alcoholic hepatitis (AH) is defined as an acute hepatic manifestation resulting from heavy alcohol intake. Histologically, alcoholic steatohepatitis (ASH) is characterized by hepatocellular steatosis, inflammation, and fibrosis. Alcohol abstinence is the sine qua non of therapy for AH and, in the milder forms, is prerequisite to clinical recovery. Severe ASH may lead to multi-organ failure such as acute kidney injury and infection, which has a major impact on survival and thus should be closely monitored. Patients with severe ASH have a drastic short-term mortality of up to 40-50%. Specific therapies should be considered for patients with severe ASH at risk of early death. Corticosteroids are the standard of care for patients with severe ASH. When corticosteroids are contraindicated, pentoxifylline may be an alternative option. Steroid responsiveness should be evaluated on the basis of Lille score. Tactically, we should explore novel therapeutic targets to suppress inflammation based on cytokine profiles, promote hepatic regeneration, limit innate immune responses, and restore altered gut mucosal integrity in severe ASH.
authors.affiliation: Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Kim
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D016031:Liver Transplantation; D010431:Pentoxifylline / Q000627:therapeutic use; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D016166:Free Radical Scavengers; D010431:Pentoxifylline