Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.8
Peer-review started: May 5, 2015
First decision: June 23, 2015
Revised: July 7, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 7, 2016
Alcohol consumption is the principal factor in the pathogenesis of chronic liver diseases. Alcoholic liver disease (ALD) is defined by histological lesions on the liver that can range from simple hepatic steatosis to more advanced stages such as alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and liver failure. As one of the oldest forms of liver injury known to humans, ALD is still a leading cause of liver-related morbidity and mortality and the burden is exerting on medical systems with hospitalization and management costs rising constantly worldwide. Although the biological mechanisms, including increasing of acetaldehyde, oxidative stress with induction of cytochrome p450 2E1, inflammatory cytokine release, abnormal lipid metabolism and induction of hepatocyte apoptosis, by which chronic alcohol consumption triggers serious complex progression of ALD is well established, there is no universally accepted therapy to prevent or reverse. In this article, we have briefly reviewed the pathogenesis of ALD and the molecular targets for development of novel therapies. This review is focused on current therapeutic strategies for ALD, including lifestyle modification with nutrition supplements, available pharmacological drugs and new agents that are under development, liver transplantation, application of complementary medicines, and their combination. The relevant molecular mechanisms of each conventional medication and natural agent have been reviewed according to current available knowledge in the literature. We also summarized efficacy vs safety on conventional and herbal medicines which are specifically used for the prevention and treatment of ALD. Through a system review, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for ALD and its complications. It is worthwhile to conduct large-scale, multiple centre clinical trials to further prove the safety and benefits for the integrative therapy on ALD.
Core tip: The aim of this article is to review the impairment of hepatocellular dysfunction in alcoholic liver diseases and their prospective managements. Specifically, we focused on the natural therapies with their efficacies and safeties. Moreover, we summarized molecular mechanisms of herbal therapy to treat alcoholic liver disease (ALD). With evidence-based natural therapy, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for this complex liver disease. It is worthwhile to conduct large-scale, multiple centre clinical trials further to prove the safety and benefits for the integrative therapy on ALD.