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Medical Management of Severe Alcoholic Hepatitis CPU Patient Companion

Clinical Practice Updates are developed under the guidance of the AGA Institute Clinical Practice Updates Committee and provide best practice advice on cutting-edge topics in the practice of gastroenterology and hepatology. The Clinical Practice Updates are based on a combination of a review of the current scientific literature and expert opinion to help guide gastroenterologists and other health-care professionals at the point of care. The below information presents important content from AGA Clinical Practice Updates in a way that will help patients better understand AGA’s best practice advice on these new, hot-button topics.
AGA Clinical Practice Update: Medical Management of Severe Alcoholic Hepatitis
The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

What is alcoholic hepatitis?

  • Alcoholic hepatitis is a serious condition that happens when a person drinks a lot of alcohol over a long period of time.
  • Alcoholic hepatitis happens in people who are considered heavy drinkers.
    • Heavy drinking is defined as regularly having more than 14 drinks per week for men, and more than 7 drinks per week for women.
  • If left untreated, alcoholic hepatitis can result in death.

Symptoms

  • Symptoms of alcoholic hepatitis include:
    • Feeling very tired.
    • Lack of appetite and weight loss.
    • Tenderness, pain, and swelling of the liver and belly.
    • Abnormal body temperature, heart rate, and breathing rate.
    • Confusion and changes in behavior.
    • Yellowing of the skin and eyes (jaundice).
  • Jaundice is a hallmark sign of alcoholic hepatitis in heavy drinkers.
  • Symptoms of Alcoholic hepatitis happen very quickly. Patients with a history of heavy drinking who experience these symptoms should be seen by a doctor immediately.

Causes

  • The cause of alcoholic hepatitis is heavy drinking over a long period of time, often for many years.
  • When a person drinks alcohol, the liver breaks it down into substances that are toxic to the body. In a healthy person who drinks moderately, these toxins are removed from the body through urine. They do not cause long-term damage to the liver.
    • Alcoholic hepatitis is caused by a high level of these toxins in the body over a long period of time.
    • These toxins may cause scarring of the liver (or cirrhosis) and make it harder for the liver to work correctly.
  • Certain heavy drinkers are more likely to get alcoholic hepatitis than others. Risk factors for alcoholic hepatitis include:
    • Being a woman.
    • Being overweight or obese.
    • Genetics.

Getting tested

  • The most accurate way to test for alcoholic hepatitis is through a liver biopsy, but this is not usually done.
    • In a liver biopsy, the doctor inserts a small needle into the liver and takes a small piece of tissue from the liver so that it can be viewed under a microscope.
  • Other ways to test for alcoholic hepatitis liver failure are to take a blood test and check for symptoms of alcoholic hepatitis. Someone is more likely to have alcoholic hepatitis if the following are true:
    • The person has a past of heavy drinking over many months or years.
    • The person has yellowing of the skin and eyes (jaundice) within 60 days after a bout of heavy drinking.
    • The person’s blood levels of certain chemicals, such as bilirubin, are higher than normal.

Treatment

  • Most persons with alcoholic hepatitis are initially hospitalized.
  • Stopping drinking
    • The best way to treat alcoholic hepatitis is to stop drinking alcohol. Patients who return to drinking heavily after having alcoholic hepatitis are more likely to die or have serious health issues.
    • You can work with your doctor to find ways to stop drinking, such as:
      • Joining a support group.
      • Taking certain medications that make you less likely to drink.
      • Seeing a therapist or counselor.
  • Drug treatment
    • Certain drugs can help reduce the liver damage that is caused by alcoholic hepatitis.
    • These drugs reduce the amount of inflammation in the body, making the liver less likely to scar and stop working.
    • The two most commonly used drugs for alcoholic hepatitis are glucocorticoids such as prednisone (a type of steroid) and pentoxifylline (or PTX).
      • Steroids are effective at treating alcoholic hepatitis, but they can have serious side effects. They should not be taken by patients with certain infections or health conditions.
      • Patients who cannot take steroids or who do not respond to steroid treatment may be prescribed PTX.
  • Nutrition
    • People with a history of heavy drinking tend to have malnutrition. This means they are not getting enough calories and nutrients to keep their body healthy.
    • Patients with alcoholic hepatitis who have malnutrition are more likely to die.
    • Treating malnutrition is an effective way to treat alcoholic hepatitis and reverse some of its effects.
      • Some patients may require a feeding tube for a while to get the nutrients they need to treat alcoholic hepatitis. Other patients can be treated by making sure they are eating enough healthy food.
      • A high-protein diet is important for treating alcoholic hepatitis. Foods that are high in protein include:
        • Meats and seafood.
        • Eggs, milk, cheese and yogurt.
        • Beans and nuts.
        • Whole grains such as whole wheat bread, brown rice and oatmeal.

Complications

  • If alcoholic hepatitis is not treated right away, it can lead to serious health issues, including:
    • Continued scarring (cirrhosis) of the liver and reduced liver function.
    • Enlarged veins (varices) in the esophagus which can lead to serious internal bleeding.
    • Brain damage or even coma from the build-up of toxins in the blood.
    • Kidney failure.