The large and growing burden of alcohol-related liver disease (ALD) – and the considerable burden of morbidity and mortality associated with it – has been a drive towards ongoing research into novel strategies for its treatment, with a particular focus upon alcohol-related hepatitis (AH). Management of alcohol-use disorder (AUD) forms the central pillar of ALD care, with evidence-based psychological and pharmacological approaches being well-established, and certain models demonstrating improved clinical outcomes when hepatology and addiction services are co-located. Corticosteroids have previously been used somewhat indiscriminately in patients with severe AH, but effective tools now exist to assess early response (and limit futile ongoing exposure). Techniques to predict risk of corticosteroid-related infection are also available, although current clinical strategies to mitigate this risk are limited. A variety of novel therapeutic approaches to AH are at different phases of trials and evidence-gathering, with some of the most promising signals related to cytokine manipulation, epigenetic modulation, and targeting of the gut microbiota (i.e. via faecal microbiota transplant). While remaining an ongoing source of debate, early liver transplant in severe AH has grown in interest and acceptability over the past decade as evidence supporting its efficacy builds, in the process challenging paradigms about mandatory pre-transplant sobriety periods. However, uncertainty remains regarding the optimal selection criteria, and whether liver transplant has a role for only a highly-limited proportion of AH patients or more widespread application. This review aims to provide an overview of this fast-moving field.

中文翻译：

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酒精相关肝病：新兴治疗策略


酒精相关性肝病 (ALD) 的巨大且不断增长的负担，以及与之相关的相当大的发病率和死亡率负担，一直推动着对其新治疗策略的持续研究，特别关注酒精相关性肝炎（啊）。酒精使用障碍 (AUD) 的管理构成了 ALD 护理的核心支柱，基于证据的心理和药理学方法已得到完善，并且某些模型表明当肝病学和成瘾服务位于同一地点时可以改善临床结果。以前曾在严重 AH 患者中不加区别地使用皮质类固醇，但现在存在有效的工具来评估早期反应（并限制无用的持续暴露）。尽管目前减轻这种风险的临床策略有限，但预测皮质类固醇相关感染风险的技术也是可用的。各种针对 AH 的新型治疗方法正处于试验和证据收集的不同阶段，其中一些最有希望的信号与细胞因子操作、表观遗传调节和肠道微生物群靶向（即通过粪便微生物群移植）相关。尽管仍是一个持续存在的争论焦点，但在过去十年中，随着支持其功效的证据不断建立，严重 AH 的早期肝移植越来越受到人们的关注和接受，在此过程中挑战了移植前强制清醒期的范例。然而，关于最佳选择标准以及肝移植是否仅对极少数 AH 患者有效还是更广泛的应用仍存在不确定性。这篇综述旨在概述这个快速发展的领域。