Diagnosis and treatment of alcoholic hepatitis

Martyna Šopauskienė1, Rugilė Dubickaitė1

1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine


Background. Harmful use of alcohol and its associated consequences is a public health priority. Worldwide, 3 million deaths every year result from the harmful use of alcohol. Its toxicity affects most organ systems, particularly the liver. Alcoholic hepatitis (AH) is an acute inflammatory liver disease caused by excessive and prolonged alcohol intake.

Aim: to determine diagnosis and treatment of alcoholic hepatitis.

Methods: a review of the literature was performed using PubMed, ClinicalKey, ScienceDirect databases.

Results. The diagnosis of AH is usually made based on clinical history, symptoms, clinical findings, and laboratory features. AH patients present a history of excessive alcohol use: in women >40 g/day, in men >60 g/day. The heavy alcohol use should have occurred for >6 months, with <60 days of absence before the onset of symptoms. The symptoms include jaundice, nausea, vomiting, anorexia, fatigue, upper abdominal pain on the right side, abstinence syndrome. Laboratory features include elevated AST, serum total bilirubin concentration, AST/ALT ratio >1.5. A liver biopsy may be considered to verify the diagnosis of AH. Treatment and prognosis depend on the severity of the disease. The main treatment for AH is alcohol cessation and nutritional therapy. Corticosteroids are the main pharmacological treatment for severe AH. Other medications include N-acetylcysteine (NAC) and granulocyte-colony stimulating factor (G-CSF). Liver transplantation may be considered in severe AH patients not responding to medical therapy. Abstinence from alcohol is one of the main goals in the treatment of alcoholic hepatitis.

Conclusions. The diagnosis of AH is based on the clinical history of alcohol abuse, symptoms including jaundice, nausea, vomiting, anorexia, fatigue, abdominal pain, abstinence syndrome, and laboratory features including elevated AST, serum total bilirubin concentration, AST/ALT ratio >1.5. The treatment of AH includes abstinence from alcohol and corticosteroids, NAC, and G-CSF.

Keywords: alcoholic hepatitis, alcohol, liver, hepatology, treatment, diagnosis, prognosis.