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EH Forrest
Journal Issue: 
Volume 37: Issue 1: 2007




There has been a dramatic increase in alcoholic liver disease in Scotland over recent years.  Alcoholic hepatitis is perhaps the most florid manifestation of this,  however  considerable  controversy  exists  regarding  its  diagnosis  and management.   This  review  indicates  that  it  is  possible  to  confidently  make  a diagnosis of alcoholic hepatitis on clinical grounds using a minimum threshold of serum bilirubin as a diagnostic criterion. All patients with alcoholic hepatitis need nutritional  assessment  and  support.  The  severity  of  alcoholic  hepatitis  can  be ascertained  using  the  Discriminant  Function,  however  the  Glasgow  Alcoholic Hepatitis Score appears to be more specific and accurate predictor of outcome. Patients  with  severe  disease  should  be  considered  for  specific  treatment.  The evidence is in favour of corticosteroids which have the added benefit of allowing responsiveness  to  the  treatment  to  be  assessed  after  one  week.  Pentoxifylline may be a useful alternative to corticosteroids. The patients with alcoholic hepatitis and  concomitant  sepsis  have  a  very  poor  prognosis.   Previously  regarded  as  a contraindication  to  specific  treatment,  it  might  be  beneficial  to  broaden  the indications for corticosteroids or pentoxifylline in these patients.