RCP Medicine Podcast Episode 102: Alcohol-related hepatitis: Diagnosis, Management and Future of care
Mar 11, 2026
Ewan Forrest, consultant hepatologist and professor with expertise in liver disease, guides a clinical dive into alcohol-related hepatitis. Clear definitions and key blood-test patterns are discussed. Practical first 72–96 hour management, infection screening, steroids and nutrition are covered. Prognostic scores, the role of neutrophil-to-lymphocyte ratio, and future treatments including transplantation debates are explored.
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AST Greater Than ALT Is A Key Biochemical Clue
- Typical liver blood tests show modest transaminase rises with AST>ALT, often ≥2:1, and transaminases usually <400 IU/L.
- Forrest links this to mitochondrial AST release and vitamin B6 deficiency in malnourished patients.
Exclude Other Causes Before Labeling Alcohol-Related Hepatitis
- Do not assume alcohol-related hepatitis immediately; exclude prehepatic, hepatic and posthepatic causes and screen for drug-induced or autoimmune liver injury.
- Use ultrasound to exclude biliary obstruction and check portal flow to rule out other acute causes.
Delay Specific Therapy For 72 To 96 Hours
- Do not start alcohol-related hepatitis–specific treatments immediately; use the first 72–96 hours to screen for infection, resuscitate and observe trajectory.
- Reassess bilirubin trend and renal function before deciding on steroids.