Severe alcoholic hepatitis: current perspectives

Cyriac Abby Philips,1 Philip Augustine,2 Praveen Kumar Yerol,3 Sasidharan Rajesh,4 Pushpa Mahadevan51The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 2Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 3Dep...

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Autores principales:	Philips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	SAH hepatitis alcohol gut microbiome stool transplant ACLF Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/5ced8810cada47079463e51dc211a591
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spelling	oai:doaj.org-article:5ced8810cada47079463e51dc211a5912021-12-02T07:31:44ZSevere alcoholic hepatitis: current perspectives1179-1535https://doaj.org/article/5ced8810cada47079463e51dc211a5912019-08-01T00:00:00Zhttps://www.dovepress.com/severe-alcoholic-hepatitis-current-perspectives-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Cyriac Abby Philips,1 Philip Augustine,2 Praveen Kumar Yerol,3 Sasidharan Rajesh,4 Pushpa Mahadevan51The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 2Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 3Department of Gastroenterology, Government Medical College and Hospital, Thrissur, Kerala, India; 4Interventional Radiology, Hepatobiliary Division, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 5Clinical Pathology, VPS Lakeshore Hospital, Nettoor, Kerala, IndiaAbstract: Severe acute alcoholic hepatitis (AH) is a catastrophic disease in the natural history of alcoholic liver disease with a very high 180-day mortality. It can present as acute on chronic liver failure with worse prognosis in the presence of infections and higher grades of liver disease severity. The clinical scenario involves a patient with a recent history of heavy alcohol consumption within three months of presentation with jaundice and characteristic liver enzyme elevation pattern with coagulopathy, hepatic encephalopathy, variceal bleeding and sepsis that results in extrahepatic organ failures. Several liver disease severities and therapy response indicators are in clinical use. Even though not approved, the only recommended treatment option for patients with severe AH is corticosteroids, which is without long term survival benefit. Novel efficacious treatment options awaiting high-quality multi-center studies include liver transplantation (involves strict selection criteria), growth factor therapy and fecal microbiota transplantation. In this exhaustive review, we discuss the definitions, disease severity, histopathology, and treatment options – past, present, and future, in patients with severe alcoholic hepatitis.Keywords: SAH, hepatitis, alcohol, gut microbiome, stool transplant, ACLFPhilips CAAugustine PYerol PKRajesh SMahadevan PDove Medical PressarticleSAHhepatitisalcoholgut microbiomestool transplantACLFDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 11, Pp 97-108 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	SAH hepatitis alcohol gut microbiome stool transplant ACLF Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	SAH hepatitis alcohol gut microbiome stool transplant ACLF Diseases of the digestive system. Gastroenterology RC799-869 Philips CA Augustine P Yerol PK Rajesh S Mahadevan P Severe alcoholic hepatitis: current perspectives
description	Cyriac Abby Philips,1 Philip Augustine,2 Praveen Kumar Yerol,3 Sasidharan Rajesh,4 Pushpa Mahadevan51The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 2Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 3Department of Gastroenterology, Government Medical College and Hospital, Thrissur, Kerala, India; 4Interventional Radiology, Hepatobiliary Division, Cochin Gastroenterology Group, Ernakulam Medical Centre, Cochin, Kerala, India; 5Clinical Pathology, VPS Lakeshore Hospital, Nettoor, Kerala, IndiaAbstract: Severe acute alcoholic hepatitis (AH) is a catastrophic disease in the natural history of alcoholic liver disease with a very high 180-day mortality. It can present as acute on chronic liver failure with worse prognosis in the presence of infections and higher grades of liver disease severity. The clinical scenario involves a patient with a recent history of heavy alcohol consumption within three months of presentation with jaundice and characteristic liver enzyme elevation pattern with coagulopathy, hepatic encephalopathy, variceal bleeding and sepsis that results in extrahepatic organ failures. Several liver disease severities and therapy response indicators are in clinical use. Even though not approved, the only recommended treatment option for patients with severe AH is corticosteroids, which is without long term survival benefit. Novel efficacious treatment options awaiting high-quality multi-center studies include liver transplantation (involves strict selection criteria), growth factor therapy and fecal microbiota transplantation. In this exhaustive review, we discuss the definitions, disease severity, histopathology, and treatment options – past, present, and future, in patients with severe alcoholic hepatitis.Keywords: SAH, hepatitis, alcohol, gut microbiome, stool transplant, ACLF
format	article
author	Philips CA Augustine P Yerol PK Rajesh S Mahadevan P
author_facet	Philips CA Augustine P Yerol PK Rajesh S Mahadevan P
author_sort	Philips CA
title	Severe alcoholic hepatitis: current perspectives
title_short	Severe alcoholic hepatitis: current perspectives
title_full	Severe alcoholic hepatitis: current perspectives
title_fullStr	Severe alcoholic hepatitis: current perspectives
title_full_unstemmed	Severe alcoholic hepatitis: current perspectives
title_sort	severe alcoholic hepatitis: current perspectives
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/5ced8810cada47079463e51dc211a591
work_keys_str_mv	AT philipsca severealcoholichepatitiscurrentperspectives AT augustinep severealcoholichepatitiscurrentperspectives AT yerolpk severealcoholichepatitiscurrentperspectives AT rajeshs severealcoholichepatitiscurrentperspectives AT mahadevanp severealcoholichepatitiscurrentperspectives
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Severe alcoholic hepatitis: current perspectives

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