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World J Gastroenterol. Mar 7, 2014; 20(9): 2143-2158
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2143
Therapy for alcoholic liver disease
Maryconi M Jaurigue, Mitchell S Cappell
Maryconi M Jaurigue, Mitchell S Cappell, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States
Mitchell S Cappell, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, United States
Author contributions: Jaurigue MM performed the review of the literature and wrote about half of the manuscript; Cappell MS composed the manuscript outline, wrote about half of the manuscript, and edited the manuscript. Both authors make equal contributions to this manuscript.
Correspondence to: Mitchell S Cappell, MD, PhD, Chief, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, United States. mscappell@yahoo.com
Telephone: +1-248-5511227 Fax: +1-248-5517581
Received: November 22, 2013
Revised: January 7, 2014
Accepted: January 20, 2014
Published online: March 7, 2014
Processing time: 104 Days and 6.7 Hours
Abstract

Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Although alcoholism is associated with more than 60 diseases, most mortality from alcoholism results from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. Important scoring systems of ALD severity include: Child-Pugh, a semi-quantitative scoring system useful to roughly characterize clinical severity; model for end-stage liver disease, a quantitative, objective scoring system used for prognostication and prioritization for liver transplantation; and discriminant function, used to determine whether to administer corticosteroids for alcoholic hepatitis. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including twelve-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum, but disulfiram can be hepatotoxic. Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone, acamprosate, and baclofen. Nutritional therapy helps reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy, a diet containing 1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting. Corticosteroids are first-line therapy for severe alcoholic hepatitis (discriminant function ≥ 32), but proof of their efficacy in decreasing mortality remains elusive. Pentoxifylline is an alternative therapy. Complications of advanced ALD include ascites, spontaneous bacterial peritonitis, esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and portopulmonary hypertension. Alcoholic cirrhotics have increased risk of developing hepatomas. Liver transplantation is the ultimate therapy for severe ALD, but generally requires 6 mo of proven abstinence for eligibility. Alcoholic cirrhotics who maintain abstinence generally have a relatively favorable prognosis after liver transplantation.

Keywords: Alcoholic liver disease; Alcoholic steatosis; Alcoholic hepatitis; Alcoholic cirrhosis; Alcoholism; Liver disease; Corticosteroids; Pentoxifylline; Liver transplantation

Core tip: Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Most of this mortality is from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. This work reviews this clinically important subject, with a focus on informing clinicians of recent advances in therapy to reduce the currently high mortality from alcoholic hepatitis and alcoholic cirrhosis.