Management of Severe Alcoholic Hepatitis: Beyond Corticosteroids

Biomarkers to identify early alcohol use disorder (AUD), alcoholic liver disease (ALD) and alcoholic hepatitis play a crucial role in predicting mortality, complications, organ failure and the recovery of hepatic function.

The identifi cation of effective therapies for moderate to severe alcoholic hepatitis is pursued based on therapeutic targets across multiple mechanisms.

While prednisolone/prednisone remains the current standard of care, its use is declining due to concerns about the risk of infection and suboptimal effi cacy.

The exploration of fecal microbiota transplantation (FMT) in expanded trials is warranted, considering its potential as a therapeutic option.

Antibiotics, although reducing infections, do not necessarily improve survival in the context of severe alcoholic hepatitis.

Ongoing research involves testing novel therapies, but consensus on endpoints is needed for a more comprehensive evaluation of their effi cacy. Additionally, there is a requirement for additional data to better explain regional differences in treatment outcomes for severe alcoholic hepatitis.