Editing Hepatitis (section)

=== Alcoholic hepatitis ===
First-line treatment of alcoholic hepatitis is treatment of alcoholism.<ref name="Harrison's Principles chapter 363 (Alcohol)" /> For those who abstain completely from alcohol ([[teetotal]]), reversal of liver disease and a longer life are possible; patients at every disease stage have been shown to benefit by prevention of additional liver injury.<ref name="Harrison's Principles chapter 363 (Alcohol)" /><ref name="Chayanupatkul & Liangpunsakul" /> In addition to referral to psychotherapy and other treatment programs, treatment should include nutritional and psychosocial evaluation and treatment.<ref name="Harrison's Principles chapter 363 (Alcohol)" /><ref name="Chayanupatkul & Liangpunsakul" /><ref name="Comparative effectiveness - meta-analysis">{{Cite journal|last1=Singh|first1=Siddharth|last2=Murad|first2=Mohammad Hassan|last3=Chandar|first3=Apoorva K.|last4=Bongiorno|first4=Connie M.|last5=Singal|first5=Ashwani K.|last6=Atkinson|first6=Stephen R.|last7=Thursz|first7=Mark R.|last8=Loomba|first8=Rohit|last9=Shah|first9=Vijay H.|date=2015-10-01|title=Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis|journal=Gastroenterology|volume=149|issue=4|pages=958–970.e12|doi=10.1053/j.gastro.2015.06.006|issn=1528-0012|pmid=26091937}}</ref> Patients should also be treated appropriately for related signs and symptoms, such as ascites, hepatic encephalopathy, and infection.<ref name="Chayanupatkul & Liangpunsakul" />

Severe alcoholic hepatitis has a poor prognosis and is notoriously difficult to treat.<ref name="Harrison's Principles chapter 363 (Alcohol)" /><ref name="Chayanupatkul & Liangpunsakul" /><ref name="Comparative effectiveness - meta-analysis" /> Without any treatment, 20–50% of patients may die within a month, but evidence shows treatment may extend life beyond one month (i.e., reduce short-term mortality).<ref name="Harrison's Principles chapter 363 (Alcohol)" /><ref name="Comparative effectiveness - meta-analysis" /><ref name="STOPAH">{{Cite journal|last1=Thursz|first1=Mark|last2=Forrest|first2=Ewan|last3=Roderick|first3=Paul|last4=Day|first4=Christopher|last5=Austin|first5=Andrew|last6=O'Grady|first6=John|last7=Ryder|first7=Stephen|last8=Allison|first8=Michael|last9=Gleeson|first9=Dermot|date=2015-12-01|title=The clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): a 2 × 2 factorial randomised controlled trial|journal=Health Technology Assessment|volume=19|issue=102|pages=1–104|doi=10.3310/hta191020|issn=2046-4924|pmid=26691209|pmc=4781103}}</ref> Available treatment options include [[pentoxifylline]] (PTX), which is a nonspecific [[TNF inhibitor]], [[corticosteroid]]s, such as [[prednisone]] or [[prednisolone]] (CS), corticosteroids with ''[[N-Acetylcysteine|N]]''[[N-Acetylcysteine|-acetylcysteine]] (CS with NAC), and corticosteroids with pentoxifylline (CS with PTX).<ref name="Comparative effectiveness - meta-analysis" /> Data suggest that CS alone or CS with NAC are most effective at reducing short-term mortality.<ref name="Comparative effectiveness - meta-analysis" /> Unfortunately, corticosteroids are contraindicated in some patients, such as those who have active gastrointestinal bleeding, infection, kidney failure, or pancreatitis.<ref name="Harrison's Principles chapter 363 (Alcohol)" /><ref name="Chayanupatkul & Liangpunsakul" /> In these cases PTX may be considered on a case-by-case basis in lieu of CS; some evidence shows PTX is better than no treatment at all and may be comparable to CS while other data show no evidence of benefit over placebo.<ref name="Comparative effectiveness - meta-analysis" /><ref name="STOPAH" /> Unfortunately, there are currently no drug treatments that decrease these patients' risk of dying in the longer term, at 3–12 months and beyond.<ref name="Comparative effectiveness - meta-analysis" />

Weak evidence suggests [[Milk Thistle|milk thistle]] extracts may improve survival in alcoholic liver disease and improve certain liver tests (serum bilirubin and [[Gamma-glutamyl transpeptidase|GGT]]) without causing side effects, but a firm recommendation cannot be made for or against milk thistle without further study.<ref>{{Cite journal|title=Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases|last1=Rambaldi|first1=Andrea|last2=Jacobs|first2=Bradly P|last3=Gluud|first3=Christian|date=2007-10-17|issn=1465-1858|language=en|doi=10.1002/14651858.cd003620.pub3|journal=Protocols|volume=2009 |pmid=17943794|pages=CD003620|issue=4|pmc=8724782 }}</ref>&nbsp;

The [[modified Maddrey's discriminant function]] may be used to evaluate the severity and prognosis in alcoholic hepatitis and evaluates the efficacy of using alcoholic hepatitis corticosteroid treatment.