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Severe alcoholic hepatitis: current perspectives

Authors Philips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P

Received 31 May 2019

Accepted for publication 18 July 2019

Published 8 August 2019 Volume 2019:11 Pages 97—108


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Gerry Lake-Bakaar

Cyriac Abby Philips,1 Philip Augustine,2 Praveen Kumar Yerol,3 Sasidharan Rajesh,4 Pushpa Mahadevan5

1The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 2Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 3Department of Gastroenterology, Government Medical College and Hospital, Thrissur, Kerala, India; 4Interventional Radiology, Hepatobiliary Division, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 5Clinical Pathology, VPS Lakeshore Hospital, Nettoor, Kerala, India

Abstract: Severe acute alcoholic hepatitis (AH) is a catastrophic disease in the natural history of alcoholic liver disease with a very high 180-day mortality. It can present as acute on chronic liver failure with worse prognosis in the presence of infections and higher grades of liver disease severity. The clinical scenario involves a patient with a recent history of heavy alcohol consumption within three months of presentation with jaundice and characteristic liver enzyme elevation pattern with coagulopathy, hepatic encephalopathy, variceal bleeding and sepsis that results in extrahepatic organ failures. Several liver disease severities and therapy response indicators are in clinical use. Even though not approved, the only recommended treatment option for patients with severe AH is corticosteroids, which is without long term survival benefit. Novel efficacious treatment options awaiting high-quality multi-center studies include liver transplantation (involves strict selection criteria), growth factor therapy and fecal microbiota transplantation. In this exhaustive review, we discuss the definitions, disease severity, histopathology, and treatment options – past, present, and future, in patients with severe alcoholic hepatitis.

Keywords: SAH, hepatitis, alcohol, gut microbiome, stool transplant, ACLF

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