The United States observes Alcohol-related liver disease as a major cause of morbidity and mortality. Alcoholic liver diseases have a wide clinicohistological spectrum, comprising fatty liver, alcoholic hepatitis, and alcoholic cirrhosis.

Fatty liver although is a benign and reversible condition, but its progression to alcoholic hepatitis and cirrhosis becomes life-threatening. Women are known to be more prone to alcohol-related liver injury possible due to the decreased gastric metabolism of alcohol due to decreased gastric alcohol dehydrogenase activity in women. Additionally, genetic factors too may predispose some persons to a greater propensity toward alcohol-induced liver toxicity. Genetic polymorphisms like mutations in the tumor necrosis factor (TNF) promoter and mutations in alcohol-metabolizing enzyme systems, including alcohol dehydrogenase, aldehyde dehydrogenase, and the microsomal ethanol oxidizing system have also been detected in patients with alcoholic liver disease. Infection with the hepatitis C virus and obesity have additionally been demonstrated as the risk factors to increase the severity of liver injury in patients with alcoholic liver disease.

Alcoholic hepatitis demands the usage of clinical history, physical examination, and laboratory testing for its diagnosis but a liver biopsy may be further needed to secure the diagnosis.

The management primarily utilizes abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Use of Corticosteroid therapy is controversial but can be utilized for patients with a discriminant function greater than 32 and/or presence of spontaneous hepatic encephalopathy in the absence of infection, gastrointestinal bleeding, and renal failure.

The liver Regeneration concept has been utilized in Alcoholic hepatitis patients by treatment with insulin and glucagon, but the results have been discouraging. Similarly, Therapies using more selective hepatotropic agents like hepatocyte growth factor seems to be promising but lacks trials due to their tumorigenic potential.

 Liver transplantation remains the only curative therapy for advanced alcoholic cirrhosis. Recent advances describing the pathogenesis of alcoholic liver disease will surely benefit novel future treatment approaches, including inhibition of tumor necrosis factor α, antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.

Source: Menon KVN, Gores GJ, Shah VH. Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease, Mayo Clin Proc,2001;76