title: Advances in alcoholic liver disease: An update on alcoholic hepatitis.
abstract: Alcoholic hepatitis is a pro-inflammatory chronic liver disease that is associated with high short-term morbidity and mortality (25%-35% in one month) in the setting of chronic alcohol use. Histopathology is notable for micro- and macrovesicular steatosis, acute inflammation with neutrophil infiltration, hepatocellular necrosis, perivenular and perisinusoidal fibrosis, and Mallory hyaline bodies found in ballooned hepatocytes. Other findings include the characteristic eosinophilic fibrillar material (Mallory's hyaline bodies) found in ballooned hepatocytes. The presence of focal intense lobular infiltration of neutrophils is what typically distinguishes alcoholic hepatitis from other forms of hepatitis, in which the inflammatory infiltrate is primarily composed of mononuclear cells. Management consists of a multidisciplinary approach including alcohol cessation, fluid and electrolyte correction, treatment of alcohol withdrawal, and pharmacological therapy based on the severity of the disease. Pharmacological treatment for severe alcoholic hepatitis, as defined by Maddrey's discriminant factor ≥ 32, consists of either prednisolone or pentoxifylline for a period of four weeks. The body of evidence for corticosteroids has been greater than pentoxifylline, although there are higher risks of complications. Recently head-to-head trials between corticosteroids and pentoxifylline have been performed, which again suggests that corticosteroids should strongly be considered over pentoxifylline.
authors.affiliation: Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
authors.forename: Randy
authors.initials: R
authors.lastname: Liang
authors.affiliation: Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
authors.forename: Andy
authors.initials: A
authors.lastname: Liu
authors.affiliation: Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.affiliation: Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
authors.affiliation: Randy Liang, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000401:mortality / Q000517:prevention & control; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D018529:Nutritional Support; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000893:Anti-Inflammatory Agents
keywords: Alcoholic Hepatitis; Alcoholic liver disease; Corticosteroids; Maddrey discriminant function; Pentoxifylline