THE TREATMENT OF ALCOHOLIC HEPATITIS

Alcoholic hepatitis is a precirrhotic lesion; it develops in only a mi nority of chronic alcohol abusers even alter decades of abuse. The cli nical spectrum of disease varies from asymptomatic hepatomegaly to flo rid hepatocellular failure with gastrointestinal bleeding and hepatic encephalopathy. Corresponding variation is observed both in morbidity and mortality. The majority of individuals with mild to moderate alcoh olic hepatitis improve significantly following abstinence from alcohol and the provision of a diet sufficient to meet their nutritional requ irements; their long-term outcome is determined largely by their abili ty to maintain abstinence from alcohol. Individuals with severe alcoho lic hepatitis require intensive nutritional support and vigorous manag ement of the complications of their liver injury: their outcome is gen erally poor. A small. carefully selected subgroup, of these very sick patients may benefit. at least in the short-term. from treatment with corticosteroids: the place of orthotopic hepatic transplantation, in t his patient group, is still the subject of debate. No other treatment modalities have been shown to confer benefit consistently. A number of new therapeutic approaches have been proposed and need to be explored .