Alcoholic liver disease (ALD) accounts for the major liver-related mortality globally. ALD can be diagnosed clinically along with blood tests, and a liver biopsy is not often required. 

Abstinence is the hallmark therapy for managing ALD, and nutritional therapy remains the first-line therapy. 

Recently the use of steroids in patients with moderate to severe alcoholic hepatitis is seen as promising, with the condition that patients be evaluated for the effectiveness of therapy at 1 week. Pentoxifylline has demonstrated remarkable effectiveness in ALD patients with renal dysfunction/hepatorenal syndrome. Biologics such as specific anti-TNFs have shown disappointing results and thus aren’t recommended to be used outside of the clinical trial setting. Transplantation remains an effective modality for patients with end-stage ALD who have shown abstinence for ≥6 months, with amazing long-term graft and patient survival rates.

More research is warranted against the safety, efficacy, and ethical concerns of liver transplant in severe ASH for patients resistant to medical therapy, ALD association with insulin resistance/metabolic syndrome, and modifying the course of ALD in the outpatient setting.

SOURCE- Frazier TH, Stocker AM, Kershner NA, Marsano LS, McClain CJ. Treatment of alcoholic liver disease. Therapeutic Advances in Gastroenterology, 2011:63-81. doi:10.1177/1756283X10378925