Alcoholic Hepatitis and Alcohol-Related Acute on Chronic Liver Failure

Alcoholic hepatitis (AH) occurs in patients with chronic and heavy alcohol consumption, via a complex interplay of pathways involving direct hepatocyte injury, intestinal dysbiosis and activation of pro-inflammatory cascade. Severe AH is defined by Maddrey discriminant function ≥32 or MELD score ≥ 20 and is often associated with systemic inflammatory response syndrome leading to acute-on chronic liver failure (ACLF). A liver biopsy is required to make a definitive diagnosis of AH, although a probable diagnosis of AH can be made in patients with history of heavy drinking and typical liver enzyme abnormalities. The only available pharmacologic therapy for severe AH is corticosteroids, but its utilities are limited by lack of long-term benefit and a significant portion of non-responders. Novel biomarkers and treatment approaches are being investigated with varying degrees of success. Recently, early liver transplantation prior to the traditional 6-month period of sobriety has emerged as a promising option for certain patients with severe AH and ACLF.