Alcoholic steatohepatitis

Severe alcoholic steatohepatitis has a poor prognosis and is characterized by jaundice and signs of liver failure Its incidence is unknown but prevalence is around 20% in cohorts of alcoholics undergoing liver biopsy Diagnosis is established with elevated liver transaminases neutrophil counts serum bilirubin and impaired coagulation and a history of excessive alcohol consumption and exclusion of other etiologies Histology is helpful but not mandatory Prognostic scores include the Maddrey s discriminant function the model of end-stage liver disease and the Glasgow Alcoholic Hepatitis Score Pathophysiology involves hepatic fat storage increased hepatic uptake of gut-derived endotoxins triggering Kupffer cell activation and release of proinflammatory triggers induction of cytochrome P4502E1 producing toxic acetaldehyde and reactive oxygen species and ethanol-mediated hyperhomocysteinemia causing endoplasmic reticulum stress Treatment includes abstinence enteral nutrition corticosteroids and possibly pentoxifylline A debate is ongoing whether certain patients with severe alcoholic steatohepatitis could be eligible for liver transplantation (C) 2010 Elsevier Ltd All rights reserved