Certain alcohol-drinkers are disposed to develop hepatitis. Both men (who drink >4 drinks a day) and women (who drink > 3 drinks a day) are exposed to increased risk of this alcohol-hepatitis. While alcohol it metabolized in the liver, when severe alcohol-associated hepatitis develops, it has a 20%-50% mortality rate.
Alcohol-associated hepatitis may presents in with similar symptoms of hepatitis of fever, abdominal pain and jaundice. However, nearly 50% of patients have underlying cirrhosis and may have coexisting decompensation (e.g., ascites, gastrointestinal bleeding, encephalopathy).
Characteristic laboratory findings include moderate transaminase elevation (50-400 IU/L), aspartate transaminase to alanine transaminase ration of more than 1.5, coagulopathy and hyperbilirubinemia (>51.3 µmol/L).
Alcohol drinking is the primary predictor of death after an attack of alcohol-associated hepatitis. Treatment to promote alcohol abstinence include:
- counselling
- cognitive behavioural or motivational therapy
- mutual aid societies
- inpatient alcohol rehabilitation
- anti-craving therapies (e.g., naltrexone, acamprosate)
High-protein and high-calorie diets with vitamin B & D supplementation is encouraged. Patients with severe alcohol-associated hepatitis, who are not responsive to medical therapy and who are committed to alcohol abstinence should be referred for liver transplant assessment.
Reference: CMAJ 2023 April 24;195:E588. doi:10.1503/cmaj.221357