title: Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review.
abstract: Alcoholic hepatitis (AH) occurs in about one-third of individuals reporting long-term heavy alcohol use. It is associated with high short-term mortality, economic burden, and hospital resources utilization. We performed this systematic review to (i) describe clinical characteristics and genomics associated with the risk of AH; (ii) discuss role and limitations of liver biopsy and prognostic scoring systems; (iii) summarize evidence regarding the currently available therapies including liver transplantation; and (iv) outline emerging therapies with areas of unmet need. Literature search was performed for studies published in English language (January 1971 through March 2016). The following search engines were used: PubMed, Elsevier Embase, PsycINFO, and Cochrane Library. For the treatment section, only randomized controlled studies were included for this review. A total of 138 studies (59 randomized, 22 systematic reviews or meta-analyses, 7 surveys or guidelines, 7 population-based, and 43 prospective cohorts) were cited. There are over 325,000 annual admissions with AH contributing to about 0.8% of all hospitalizations in the United States. Liver biopsy may be required in about 25 to 30% cases for uncertain clinical diagnosis. Corticosteroids with or without N-acetylcysteine remains the only available therapy for severe episodes. Data are emerging on the role of liver transplantation as salvage therapy for select patients. Abstinence remains the most important factor impacting long-term prognosis. Results from the ongoing clinical trials within the National Institute on Alcohol Abuse and Alcoholism-funded consortia are awaited for more effective and safer therapies. AH is a potentially lethal condition with a significant short-term mortality. A high index of suspicion is required. There remains an unmet need for noninvasive biomarkers for the diagnosis, and predicting prognosis and response to therapy.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Sudha
authors.initials: S
authors.lastname: Kodali
authors.affiliation: UAB Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Vucovich
authors.affiliation: Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Victor
authors.initials: V
authors.lastname: Darley-Usmar
authors.affiliation: Division of Liver Diseases, Mount Sinai School of Medicine, New York City, New York.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D008954:Models, Biological
chemical_list: D000305:Adrenal Cortex Hormones; D000111:Acetylcysteine
keywords: Alcoholic Liver Disease; Alcoholism; Corticosteroids; Pathophysiology; Recidivism