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Alcoholic Hepatitis: Natural History and Evaluation of Prednisolone Therapy

RICHARD A. HELMAN, M.D.; MICHAEL H. TEMKO, M.D.; SYLVANUS W. NYE, M.D.; and HAROLD J. FALLON, M.D.
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▸Requests for reprints should be addressed to Harold J. Fallon, M.D., Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, N.C. 27514


Chapel Hill, North Carolina


Ann Intern Med. 1971;74(3):311-321. doi:10.7326/0003-4819-74-3-311
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Thirty-seven patients with acute alcoholic hepatitis documented by liver biopsy were studied on a research unit during the healing phase. The clinical picture varied from hepatic coma to an asymptomatic condition. Serum glutamic-oxalacetic transaminase was abnormal in all patients, but the most severely ill had significantly lower albumin levels and more prolonged prothrombin times. Patients were randomly given prednisolone or placebo for 4 weeks, and liver biopsy was repeated at 4 weeks and 4 months. Seven of 15 patients with hepatic encephalopathy died, including all 6 on placebo and 1 of 9 given prednisolone. Prednisolone improved caloric intake in the severe and moderately ill patients. Five of 9 patients with no cirrhosis on first biopsy developed cirrhosis during the 4-month follow-up. Histologic improvement was slow, and prednisolone did not affect the rate of improvement or prevent cirrhosis.

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