Ramond MJ, Poynard T, Rueff B, et al. A randomized trial of prednisolone in patients with severe alcoholic hepatitis. N Engl J Med 1992;326(8):507-512. The use of steroids in alcoholic hepatitis remains controversial. In this randomized, double-blinded study, 28-day treatment with prednisolone vs. placebo was compared in patients with severe biopsy-proven alcoholic hepatitis (Discriminant Function >32). Prednisolone is favored over prednisone because prednisone is converted to its active form, prednisolone, in the liver. This study showed a decrease in 66-day mortality with use of prednisolone (45% vs. 88%). Primarily based on this study as well as two other RCTs (Mendenhall et al NEJM 1984;311:1464 and Carithers et al Ann Intern Med 1989;110: 685), the American College of Gastroenterology has proposed guidelines for treating patients with prednisolone in the setting of severe alcoholic hepatitis with discriminant function >32 and/or hepatic encephalopathy (McCullogh AJ, et al. American Journal of Gastroenterology 1998;93:2022-2036). These guidelines, however, have remained controversial given that other studies have not shown a benefit from steroids (Depew W et al Gastro 1980;78:524 and Blitzer et al. Am J of Diges Dis 1977;22:477) and the largest RCT (Mendenhall et al.) was not stratified by discriminant function data. Although meta-analyses still disagree, a recent analysis of the individual data (Mathurin et al. J Hepatol 2002;36:480) supports the short term benefit of corticosteroids.