Affiliation:
1. Department of Medicine University of California San Diego California La Jolla USA
2. Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Nagano Matsumoto Japan
3. Department of Medicine VA San Diego Healthcare System California San Diego USA
Abstract
AbstractAcute alcohol‐associated hepatitis (AH) is a syndrome that occurs in heavy and long‐term drinkers and results in severe jaundice and liver failure. The mortality rate in severe cases is 20%–50% at 28 days, and in cases that do not improve despite appropriately timed corticosteroid therapy, the mortality rate reaches 70% at 6 months. The only curative treatment is early liver transplantation, but less than 2% of patients with severe AH are eligible. In order to improve the prognosis, diagnostic tools are needed to detect appropriate cases at risk of severe conditions, and new therapies need to be developed that can replace corticosteroids. Recent research has revealed that the pathogenesis of AH involves a complex of factors, including changes in the gut microbiota, inflammatory and cytokine signalling, oxidative stress and mitochondrial dysfunction, and abnormalities in the hepatic regenerative capacity. Non‐invasive diagnostic tools focusing on these specific pathologies have been reported in recent years. In addition, several novel agents targeting specific pathways are currently being developed and tested in clinical trials. This review will provide an overview of alcohol‐associated hepatitis and focus on the latest diagnostic tools, particularly non‐invasive biomarkers, and novel therapies.
Funder
Biomedical Laboratory Research and Development, VA Office of Research and Development
National Institutes of Health