Liver, Pancreas, and Biliary Tract: Clinical ReviewsAcute Alcoholic HepatitisCeccanti, Mauro PhD*; Attili, Adolfo PhD†; Balducci, Giuseppe MD‡; Attilia, Fabio MD*; Giacomelli, Stefano MD*; Rotondo, Claudia MS*; Sasso, Guido Francesco PhD*; Xirouchakis, Elias MD§; Attilia, Maria Luisa MD*Author Information *Alcohol Liver Disease Unit †II Gastroenterology Unit, University “La Sapienza”, Roma, Italy ‡Istituto Superiore di Sanità, Roma, Italy §1st IKA Hospital Gastroenterology Unit, Athens, Greece Reprints: Prof. Mauro Ceccanti, PhD, Dipartimento di Medicina Clinica, Università “La Sapienza”, Viale dell'Università, 37, 00185 Roma, Italy (e-mail: [email protected]). Received for publication February 4, 2006; accepted June 5, 2006 Journal of Clinical Gastroenterology: October 2006 - Volume 40 - Issue 9 - p 833-841 doi: 10.1097/01.mcg.0000225570.04773.5d Buy Metrics Abstract Acute alcoholic hepatitis (AAH) is a frequent inflammatory liver disease with high short-term mortality rate. In this review, relationships between alcohol abuse and the epidemiology and the outcomes of AAH are discussed, as well as AAH pathogenesis. The role of endotoxins, tumor necrosis factor α, fibroblasts, and immune response to altered hepatocyte proteins is discussed. The need of a careful prognosis, supported by the use of Maddrey score, by the model for end-stage liver disease [Mayo end-stage liver disease (MELD)] score or by the Glasgow alcoholic hepatitis score, is outlined, as the use of the most effective drugs (glucocorticoids and anti-tumor necrosis factor α infliximab) is recommended only in severe AAH cases. The problems of liver transplant in severe AAH, and the need of a 6-month alcohol abstinence before transplant, are discussed, as well as the need of a careful psychologic assessment before the transplant. © 2006 Lippincott Williams & Wilkins, Inc.