The natural history of alcoholic hepatitis varies according to the severity and the nature of the disease. There are several forms of liver disease that can manifest from alcohol abuse. These are fatty liver, alcoholic hepatitis, and cirrhosis. The consumption of alcohol is associated with the accumulation of triglycerides in hepatocytes. This accumulation of triglycerides secondary to alcohol requires that the rate of formation must exceed the rate of its release in the form of very low-density lipoproteins, or by the oxidation of fatty acids. Symptoms include anorexia, jaundice, icteris, and hepatosplenomegaly. An hepatic bruits may be appreciated in the right upper quadrant. Transaminasemia with an AST/ALT ratio of two to three is characteristic.
Chronic alcohol abuse results in a variety of systemic medical complications. Effects involve the nervous system, gastrointestinal tract, cardiovascular, endocrine, and hematologic systems. Alcoholic hepatitis has a direct relationship with the amount and duration of alcohol use. Women are more susceptible than men to the chronic effects of alcohol. Alcoholic hepatitis and cirrhosis require chronic abuse of larger quantities of alcohol over many years. Men who ingest 100 to 200 grams of ethanol daily for more than 5 years are at high risk for serious liver disease. The incidence of alcoholic hepatitis and cirrhosis increases as the amount and duration of alcohol use increases. However, only 50% of men who admit to drinking 200 to 300 grams of alcohol daily for over 20 years develop cirrhosis. The mechanisms of cellular injury include toxic injury, malnutrition, immunological mechanisms, and individual susceptibility. This suggests that there are other factors that predispose persons to cirrhosis. There is no clear-cut relationship between continued alcohol abuse and the development of cirrhosis among patients with alcoholic hepatitis. Thus, not all patients with alcoholic hepatitis who continue to drink will progress to cirrhosis. Alcoholic hepatitis has morbidity and mortality that approaches that of fulminant hepatitis.
Therapy includes abstinence from alcohol consumption. Patients with mild disease may respond to pentoxifylline. More severe cases may respond to prednisolone 40 mg/day. Since these patients are actively drinking, liver transplantation is not an option; however, they are at risk for the development of delirium tremens when alcohol is discontinued abruptly.