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Arch Hellen Med, 27(5), September-October 2010, 767-775


Current trends in the diagnosis and treatment of alcoholic hepatitis

Second Department of Medicine, "Hippokrateion" General Hospital of Athens, Medical School, University of Athens, Athens, Greece

Alcoholic hepatitis is a clinical syndrome of jaundice and liver failure that generally occurs after decades of heavy alcohol use. The typical age of presentation is between 40 and 60 years, and female sex is an independent risk factor. Alcoholic hepatitis is a treatable form of alcoholic liver disease. Since up to 40% of patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome, appropriate diagnosis and treatment are essential. Liver biopsy is a valuable diagnostic aid when it is possible for it to be performed. A variety of scoring systems: Maddrey index, Glasgow score, model for end stage liver disease (MELD), Lille score, have been used to assess the severity of alcoholic hepatitis and to guide treatment. Treatment of alcoholic hepatitis includes the general measures for patients with decompensated liver disease and specific measures directed at the underlying liver injury. Immediate and lifetime abstinence from alcohol use is the cornerstone of recovery, and in addition it is essential to prevent the progression to liver failure and death. Malnourished subjects should be given adequate caloric and protein support. The use of corticosteroids is controversial. Pentoxifylline may be of benefit, by preventing development of the hepatorenal syndrome. This review focuses on the most recent developments in diagnosis and treatment of alcoholic hepatitis.

Key words: Alcoholic hepatitis, Corticosteroids, Glasgow score, Lille score, Maddrey index, Model for end stage liver disease (MELD), Pentoxifylline.

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