26. Alcoholic Liver Disease

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Srinivasan Dasarathy MD and
  2. Arthur J. McCullough MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch26

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Dasarathy, S. and McCullough, A. J. (2011) Alcoholic Liver Disease, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch26

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

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Keywords:

  • Alcoholic liver disease;
  • alcohol dependence;
  • gene polymorphisms;
  • cirrhosis;
  • oxidative stress;
  • hepatitis;
  • corticosteroids;
  • abstinence;
  • liver transplantation;
  • liver metabolism;
  • liver biopsy;
  • pentoxifylline

Summary

Alcoholic liver disease is one of the commonest causes of cirrhosis and the second leading indication for liver transplantation in the United States. The disease spectrum ranges from mild steatosis to end-stage cirrhosis. Alcoholic hepatitis is a stage that carries a high mortality but is potentially reversible. A number of biochemical and immunologic alterations induced by alcohol result in hepatocellular injury, death, and fibrosis. The absolute amount and duration of alcohol consumed are the exogenous factors responsible for liver injury that are additive to the endogenous factors, which include polymorphisms in the genes regulating alcohol metabolism, underlying liver diseases due to viral hepatitis and iron-storage disorders, gender, and body weight. Binge drinking, especially in obese subjects, is being recognized as a common setting and significant risk for advanced liver injury disease. The mainstay of therapy at all stages of the disease is abstinence. Of the current therapeutic options, corticosteroids are the only proven effective therapy of severe alcoholic hepatitis. Pentoxifylline is beneficial in reducing renal failure-related mortality in acute alcoholic hepatitis. Once cirrhosis has developed, the prevention of complications and liver transplantation are the therapeutic options. Outcome after liver transplantation in patients with alcoholic cirrhosis is similar to or better than that of patients with nonalcoholic liver disease. However, recidivism and recurrence of disease are concerns and increasing evidence suggests that a period of abstinence that is as yet precisely defined helps reduce recidivism. There remains an urgent need for pathogenesis-based therapeutic options for reversing alcohol-induced liver injury that is clinically valid.