Alcohol use disorders claim millions of life globally. Alcohol consumption accounts for maximum liver disease mortality and elevated social and economic costs. Alcoholic liver disease (ALD) may have an acute presentation (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). Chronic alcohol abuse leads to Liver steatosis as the most frequent primary change. Changes in alcohol metabolism may further cause inflammatory reactions, resulting in alcoholic hepatitis or chronic liver disease.

While Simple steatosis is reversible after some weeks of abstinence; steatohepatitis is a fibrogenic process that can induce changes leading to cirrhosis. Further, Steatohepatitis is also reversible, with some amount of persistent fibrosis. Steatohepatitis can coincide with liver cirrhosis in active alcoholics and lead to decompensation of cirrhosis. 

The severity and prognosis of alcohol-induced liver disease are directly proportional to the amount, pattern and duration of alcohol consumption, and to the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. 

The liver disease presentation ranges from a benign steatosis form to liver cirrhosis with significant morbidity, mortality and life expectancy shortening.  Patients with steatosis usually do not have any symptoms but may show slightly elevated liver function tests and an enlarged liver. Acute alcoholic hepatitis may have a clinical presentation of nausea, loss of appetite, gradual loss of weight, icterus and other symptoms of liver dysfunction.

Alcoholic liver disease patients usually show increased GGT, AST/ALT ratio greater than 2 and increased MCV in the laboratory testing, while sonography reveals enlarged liver and signs of steatosis.

Advanced cirrhosis patients show median survival of only 1-2 years. Similarly, severe acute alcoholic hepatitis (AH) may show nearly 50% mortality. Although corticoids, pentoxifylline and enteral nutrition remain the treatment for AH, the evidence-based data are still conflicting. 

Absolute abstinence remains the prime necessity for any treatment of acute or chronic ALD, with other therapeutical procedures being of a supportive nature and questionable significance. 

Acamprosate has shown promising results in supporting continuous abstinence in alcohol-dependent patients. Patients with advanced liver cirrhosis with favourable conditions are considered for liver transplantation, which markedly prolongs life expectancy. 

Thus ALD can be prevented by preventing alcohol abuse, but liver injury prevention in active alcohol abusers is not clinically applicable.

Source:  Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol. 2012;4(3):81-90. doi:10.4254/wjh.v4.i3.81    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/