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World J Gastroenterol. Mar 7, 2014; 20(9): 2159-2167
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2159
Pharmacotherapy of acute alcoholic hepatitis in clinical practice
Ludovico Abenavoli, Natasa Milic, Samir Rouabhia, Giovanni Addolorato
Ludovico Abenavoli, Department of Health Sciences, University Magna Graecia, Campus Germaneto, 88100 Catanzaro, Italy
Natasa Milic, Department of Pharmacy, University of Novi Sad, 21000 Novi Sad, Serbia
Samir Rouabhia, Department of Internal Medicine, University Hospital Center Touhami Benfis, Batna 05000, Algeria
Giovanni Addolorato, Department of Internal Medicine, Catholic University of Rome, 00168 Rome, Italy
Author contributions: Abenavoli L designed the paper, performed research of literature data and wrote the paper; Milic N and Rouabhia S critically revised the paper; Addolorato G analysed data and drafted the article.
Correspondence to: Ludovico Abenavoli, MD, PhD, Department of Health Sciences, University Magna Graecia, Campus Germaneto, Viale Europa, 88100 Catanzaro, Italy. l.abenavoli@unicz.it
Telephone: +39-961-3694387 Fax: +39-961-754220
Received: October 17, 2013
Revised: January 2, 2014
Accepted: January 14, 2014
Published online: March 7, 2014
Abstract

Severe alcoholic hepatitis (AH) is an acute form of alcohol induced liver disease with a poor prognosis that is seen in the patients who consume large quantities of alcohol. The diagnosis of AH is based on the appropriate alcohol intake history and is supported with clinical and histological features, and several scoring systems. Glucocorticoids are the mainstay for treating severe AH with pentoxifylline used as an alternative to steroids in addition to total alcohol abstinence. Liver transplantation is a possible therapeutic option for severe AH. Among the anti-craving medications able to improve abstinence rate, baclofen seems to be effective and safe in the alcoholic patients affected by severe liver damage.

Keywords: Severe alcoholic hepatitis, Maddrey’s discriminant function, Glucocorticoids, Baclofen, Orthotopic liver transplantation, Alcoholic liver disease

Core tip: The therapy of severe alcoholic hepatitis (AH) is a problem in clinical practice due to the complex of the pathogenetic mechanisms involved. However, several treatment options are now available. The specific treatment of AH is directed to acute injury in order to block the progression of the fibrosis. Orthotopic liver transplantation is a possible therapeutic option for severe AH in the non-responder patients. Baclofen seems to be effective and safe anti-craving drug able to improve abstinence in patients with severe AH.