Alcoholic Hepatitis

Original Article

Glucocorticoids plus N-Acetylcysteine in Severe Alcoholic Hepatitis

E. Nguyen-Khac and Others

Severe acute alcoholic hepatitis is a life-threatening liver disease. Although glucocorticoid treatment is recommended and improves survival, the mortality remains high, with 35% of patients dying within 6 months.

Clinical Pearls

  How does chronic alcohol consumption lead to hepatitis?

Chronic alcohol consumption increases intestinal permeability, worsens endotoxemia, stimulates Kupffer cells, and thus increases production of proinflammatory cytokines. High levels of tumor necrosis factor α (TNF-α) activate cell-death pathways and induce the production of reactive oxygen species, notably superoxide anions, by the hepatocyte mitochondria, leading to cell death.