Acute alcoholic hepatitis is often reported in patients with chronic and active heavy alcohol use. It is characterized initially either as acute or chronic liver failure, with severe episodes demonstrating about 30-40% mortality at 1 month from presentation, if not identified and treated. 

Alcoholic hepatitis patients are managed with supportive therapy for abstinence and nutritional supplementation in those with reduced caloric intake. A recently published STOPAH (Steroids or Pentoxifylline for Alcoholic Hepatitis) Study demonstrated corticosteroids to benefit only short-term mortality and pentoxifylline being not of expected advantage. Furthermore, these drugs showed no effects on medium- and long-term mortality, which is primarily caused by abstinence from alcohol. 

With the emerging recommendations for liver transplantation, it could serve as an important rescue option for a very highly select group of AH patients. However, its use in AH patients demands more trials for emanating protocols for selecting cases and for posttransplant management. 

Many trials determining the efficacy and safety of new or repurposed compounds in severe AH are underway. These drugs are targeting different pathways in the pathogenesis of AH as the gut–liver axis, the inflammatory cascade, and liver injury. 

The combined efforts of researchers and clinicians, supported by funding from the National Institute on Alcohol Abuse and Alcoholism, will surely lead to the finding of effective and safe pharmacological interventions for severe AH.

SOURCE- Singal AK, Shah VH. Therapeutic Strategies for the Treatment of Alcoholic Hepatitis, Semin Liver Dis 2016; 36(01): 056-068. DOI: 10.1055/s-0036-1571297