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World J Hepatol. Mar 27, 2012; 4(3): 81-90
Published online Mar 27, 2012. doi: 10.4254/wjh.v4.i3.81
Alcoholic liver disease
Radan Bruha, Karel Dvorak, Jaromir Petrtyl
Radan Bruha, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
Karel Dvorak, Jaromir Petrtyl, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
Author contributions: Bruha R contributed to this work as the main author; Dvorak K and Petrtyl J wrote the revisited chapters “Treatment” and “Introduction (Epidemiology)”.
Supported by Grant IGA MZCR NT 11 247 (The role of protective mechanisms, oxidative stress and inflammatory reaction in the progression of liver damage in patient with metabolic syndrome and possible influence of antioxidative factors on the prevention of liver damage in experimental model of NASH); UK SVV 3362 (Regulatory parameters in the pathogenesis of inflammatory and oncologic diseases)
Correspondence to: Radan Bruha, MD, PhD, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, U Nemocnice 2 st, 12808 Prague, Czech Republic. bruha@cesnet.cz
Telephone: +420-224-962506 Fax: +420-224-923524
Received: February 28, 2011
Revised: September 7, 2011
Accepted: March 17, 2012
Published online: March 27, 2012
Abstract

Alcohol use disorders affect millions of individuals worldwide. Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs. Alcoholic liver disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). The severity and prognosis of alcohol-induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years. Severe acute alcoholic hepatitis (AH) is associated with mortality as high as 50%. It has been managed with corticoids, pentoxifylline and enteral nutrition, although evidence based data are still conflicting. Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH. Absolute abstinence is a basic condition for any treatment of acute or chronic ALD, the other therapeutical procedure being of a supportive nature and questionable significance. Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alcohol dependent patients. Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation, which leads to a markedly prolonged life expectancy. The crucial step in ALD prevention is in the prevention of alcohol abuse, whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.

Keywords: Alcohol; Alcoholic liver disease; Liver cirrhosis; Liver fibrosis; Steatohepatitis; Steatosis