Alcohol associated Hepatitis (AlcHep)

 In patients with high Etoh intake:

  • On an avg. 40g daily (♀) / 60g daily (♂) for 6 months
  • Last intake within last 8/52 of presentation
Grim outcome: AH a/w 20% mortality

It is an immune-mediated hepatitis, thought to be secondary to 
1) Immune activation directed at damaged hepatocytes from alcohol injury
2) High microbial load to liver, due to loss of integrity of tight-junctions in intestine


Nutrition
  • No strong evidence suggesting utility, but generally thought to be a good thing
  • Calorie: Target 30 kcal/kg/day with night time snacks
  • If not able to have enough calories orally,  consider enteral feeding

Steroids:
  • Consider using, once infection has been conclusively ruled out
  • STOPAH - 1100 patients, showed HR 0.6 (28 days), and no benefit at 3 months (HR 1.02) or 1 yr (HR 1.01)

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