Alcoholic Hepatitis (Treatment)

Depends on the severity of disease, most commonly measured by Maddrey’s Discriminant Function:
                                  DF = 4.6 x (PT – control) + bilirubin

A score > 32 is associated with very high short-term mortality (>35% at one month) and is an indication for steroids or pentoxifylline.

1)   Steroids – mixed data, but most show benefit with severe alcoholic hepatitis.  AASLD/ACG Guidelines from 2009 recommend Prednisolone 40 mg / day x 4 weeks, +/- a subsequent taper, for patients with a discriminant function > 32.

2)   Pentoxifylline – inhibitor of TNF synthesis.  Rationale is that TNF levels are increased in alcoholic hepatitis, possibly contributing to the pathophysiology.  Again, there is mixed data, but most studies suggest a decrease in mortality and a decrease in progression to hepatorenal syndrome.
The AASLD/ACG Guidelines recommend Pentoxifylline 400 mg po tid x 4 weeks for patients with a discriminant function >32 as an alternative to steroids.

The other main staple of treatment of alcoholic hepatitis is intensive nutritional support, including vitamin repletion and IVFs. 

(Chanu Rhee MD, 2/11/11)