Lecture: alcoholic hepatitis

Today’s lecture focused on management of alcoholic hepatitis.  As a background comment, of all the major causes of mortality in the United States, only liver disease is significantly on the rise in the past three decades.  Alcohol of course plays a part in this (with NASH and HCV main reasons).

Upon presentation with alcoholic hepatitis, a discriminant function should be calculated- and corticosteroids started if score > 32.  Contraindication for steroids includes GI bleeding, sepsis +/- acute renal failure.  Pentoxyfillene is an alternative to corticosteroids, but there is limited data on its efficacy and is only really known to prevent the development of hepatorenal syndrome.

If after 7 days of corticosteroids there is no improvement, a liver biopsy should be performed to better understand the reasons.  1) is there an alternative explanation for the illness, or 2) is it a cirrhotic liver that has decompensated and accounts for the persistantly high bilirubin?  The Lille Model is also useful to calculate at day #7 and if > 0.45, a poor prognosis is concluded.

Let us not forget how important nutrition is in the patient with alcoholic hepatitis.  Nearly 90% are malnourished upon presentation, and 2500 to 3000 kcal are needed daily.  Enteral feeding via NG tube should always be considered. 

For a meta-analysis of the efficacy of cortiosteroids in this population of patients, click on the link below to a recent article in Gut:

Steroids for Severe Alcoholic Hepatitis (Gut, 2011)

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