Résumé : Severe alcoholic hepatitis is a serious disease, which mostly affects patients with underlying cirrhosis and which may compromise vital outcome. Its diagnosis is facilitated by liver biopsy, which is performed via a transjugular procedure, and which should be proposed to every patient who suffers from a recent onset (less than three months) of jaundice, in the absence of another cause. Severity of alcoholic hepatitis is defined by a Maddrey function above or equal to 32, which corresponds to the threshold that meads to initiation of prednisolone (or pentoxifylline) for 28 days. Initiation of corticosteroids must be preceded by a systematic infection screening and prednisolone's efficacy is estimated after seven days by the Lille score. When prednisolone fails in improving liver function, few therapies are efficient and liver transplantation might be discussed in a subgroup of very carefully selected patients.