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World J Hepatol. Aug 27, 2011; 3(8): 205-210
Published online Aug 27, 2011. doi: 10.4254/wjh.v3.i8.205
Corticosteroids and pentoxifylline for the treatment of alcoholic hepatitis: Current status
Ashwani K Singal, Ishmeet Walia, Anjna Singal, Roger D Soloway
Ashwani K Singal, Ishmeet Walia, Anjna Singal, Roger D Soloway, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0764, United States
Ashwani K Singal, Roger D Soloway, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905-0001, United States
Author contributions: Singal AK drafted and revised the manuscript; Walia I and Singal A both worked on the tables, figures and references; Soloway RD supervised and reviewed the final version.
Correspondence to: Ashwani K Singal, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905-0001, United States. singal.ashwani@mayo.edu
Telephone: +1-507-2664056 Fax: +1-507-2664056
Received: November 28, 2010
Revised: June 15, 2011
Accepted: July 28, 2011
Published online: August 27, 2011
Abstract

The treatment of choice for patients with severe alcoholic hepatitis (AH) is use of corticosteroids. Many randomized well designed studies have been reported from all over the world on the use of corticosteroids in the treatment of AH. However, the data on the efficacy of corticosteroids in these patients have been conflicting. Initial meta-analyses also failed to show beneficial effects of corticosteroids. Based on individual data meta-analysis showing clear benefit of corticosteroids amongst patients with severe AH (modified discriminant function of 32 or more), led American College of Gastroenterology to recommend use of corticosteroids as the first line treatment option amongst patients with severe AH. However, corticosteroids are relatively contraindicated amongst patients with severe AH and coexistent sepsis, gastrointestinal bleeding, and acute pancreatitis. These patients may be candidates for second line treatment with pentoxifylline. Further, specific treatment of AH with corticosteroids far from satisfactory with as many as 40%-50% of patients failing to respond to steroids, thus classified as non-responsive to steroids. The management of these patients is a continuing challenge for physicians. Better treatment modalities need to be developed for this group of patients in order to improve the outcome of patients with severe AH. This article describes at length the available trials on use of corticosteroids and pentoxifylline with their current status. Route of administration, dosage, adverse effects, and mechanisms of action of these two drugs are also discussed. Finally, an algorithm with clinical approach to management of patients who present with clinical syndrome of AH is described.

Keywords: Corticosteroids; Pentoxifylline; Alcoholic hepatitis