Corticosteroids in the management of alcoholic hepatitis.

The pathophysiology of alcoholic hepatitis and the use of corticosteroids in the management of alcoholic hepatitis are described. Alcoholic hepatitis is a chronic, progressive, often fatal disease. Symptoms may be absent or may range from mild to severe, with little correlation between clinical and histologic findings. A definitive diagnosis can be made only through histologic examination of the liver. Biochemical liver tests may help in diagnosing or staging alcoholic hepatitis. Prognosis depends on the extent of underlying liver disease, the presence of other complications of liver disease, concomitant disease states, and abstinence from use of alcohol. Therapy has traditionally consisted of supportive care. Corticosteroids have been widely studied in the management of alcoholic hepatitis, but lack of consistency in time to treatment, proportion of female subjects, and disease severity make it difficult to draw conclusions from these studies. Data suggest that corticosteroid therapy may reduce short-term mortality among patients with alcoholic hepatitis who also have hepatic encephalopathy. This beneficial effect depends on the absence of gastrointestinal bleeding. Corticosteroid therapy may be warranted in patients with alcoholic hepatitis with encephalopathy but no gastro-intestinal bleeding. Further trials are needed to assess the long-term benefit of corticosteroids and to determine the optimum dosage.