Treatment

• Advise immediate alcohol cessation and monitor for alcohol withdrawal syndrome.

• Ensure adequate calorie and micronutrient intake.

• In patients with severe disease, consider glucocorticoid therapy and referral for early liver transplantation.

• Prevent and manage comorbidities and complications

Alcohol cessation

Patients with alcoholic hepatitis may be very malnourished. Consider specialist consultation for specialized nutritional support.

Evidence regarding the benefit of pharmacological treatment for alcoholic hepatitis is mixed.

Glucocorticoids

• Indication: Severe alcoholic hepatitis and no contraindications

• Preferred agents

  • Prednisolone

  • Methylprednisolone

• Monitoring: assess response after 4–7 days of treatment with glucocorticoids.

Other medications may be considered for patients with severe alcoholic hepatitis.

• N-Acetylcysteine

  • Evidence that N-acetylcysteine improves outcomes is limited, but the risks of treatment are low.

• Pentoxifylline

  • No longer recommended by the AASLD

• Consider in patients with the following:

  • No response to supportive or pharmacological management

  • Favorable psychosocial profiles

Liver transplantation may be considered in selected patients with acute alcoholic hepatitis, even if they have not abstained from alcohol for the required 6 months.