Othman AAA. From rescue to recovery: Reframing severe alcoholic hepatitis management through 90-day survival. World J Gastroenterol 2025; 31(43): 113141 [DOI: 10.3748/wjg.v31.i43.113141]
Corresponding Author of This Article
Amira A A Othman, MD, PhD, Chief Physician, Professor, Department of Internal Medicine, Suez University, Cairo-Suez Road, Suez 43511, Egypt. amira.othman@med.suezuni.edu.eg
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 21, 2025 (publication date) through Nov 20, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Othman AAA. From rescue to recovery: Reframing severe alcoholic hepatitis management through 90-day survival. World J Gastroenterol 2025; 31(43): 113141 [DOI: 10.3748/wjg.v31.i43.113141]
World J Gastroenterol. Nov 21, 2025; 31(43): 113141 Published online Nov 21, 2025. doi: 10.3748/wjg.v31.i43.113141
From rescue to recovery: Reframing severe alcoholic hepatitis management through 90-day survival
Amira A A Othman
Amira A A Othman, Department of Internal Medicine, Suez University, Suez 43511, Egypt
Author contributions: Othman AAA conceptualized the manuscript theme, reviewed the relevant literature, and wrote the manuscript.
Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amira A A Othman, MD, PhD, Chief Physician, Professor, Department of Internal Medicine, Suez University, Cairo-Suez Road, Suez 43511, Egypt. amira.othman@med.suezuni.edu.eg
Received: August 18, 2025 Revised: September 30, 2025 Accepted: October 22, 2025 Published online: November 21, 2025 Processing time: 96 Days and 12.9 Hours
Abstract
Severe alcoholic hepatitis remains one of hepatology’s most urgent challenges, with rapid clinical deterioration and high early mortality. This manuscript comments on and contextualizes the recent systematic review by Quiñones-Calvo et al, which redirects attention from short-term endpoints toward 90-day survival, integrating evidence from associated clinical studies. For decades, corticosteroids have been the mainstay of treatment, reducing 28-day mortality but offering limited benefit for three months. The review emphasizes that the most critical threats to recovery, late infections, renal decline, and relapse, often emerge after the first month. By synthesizing recent studies, it highlights promising interventions such as fecal microbiota transplantation (FMT), which improved 90-day survival in a small randomized trial, and granulocyte colony-stimulating factor (G-CSF), which showed a robust survival benefit in a large retrospective cohort, alongside emerging strategies like plasma exchange and targeted biologics. These findings support a shift toward a two-phase care model: Early stabilization followed by recovery consolidation. For clinicians, such a model may help guide treatment decisions, with therapies like FMT or G-CSF warranting consideration in corticosteroid non-responders, pending further validation in larger randomized controlled trials. Adoption of 90-day survival as a central metric could bridge the gap between initial rescue and sustained remission, providing a more realistic measure of therapeutic success in one of hepatology’s most unforgiving conditions.
Core Tip: Severe alcoholic hepatitis (SAH) is characterized by high short-term mortality, yet traditional 28-day endpoints overlook late complications that often determine recovery. This manuscript highlights a systematic review advocating 90-day survival as a more meaningful metric, capturing threats such as infections, renal decline, and relapse. Emerging therapies, fecal microbiota transplantation and granulocyte colony-stimulating factor, show potential in this extended window, particularly for corticosteroid non-responders. A proposed two-phase care model, early stabilization followed by recovery consolidation, may bridge the gap between initial rescue and sustained remission in SAH.
