Pathogenesis, diagnosis, and treatment of alcoholic liver disease

K. V.N. Menon, G. J. Gores, V. H. Shah

Research output: Contribution to journalReview article

106 Scopus citations

Abstract

Alcohol-related liver disease is a major cause of morbidity and mortality in the United States. Alcoholic liver disease encompasses a clinicohistological spectrum, including fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is a benign and reversible condition, but progression to alcoholic hepatitis and cirrhosis is life-threatening. Alcoholic hepatitis is diagnosed predominantly on clinical history, physical examination, and laboratory testing, although liver biopsy is often necessary to secure the diagnosis. The major focus of management is abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Corticosteroid therapy is controversial but should be con sidered in 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 only curative therapy for advanced alcoholic cirrhosis is liver transplantation. Several recent advances in understanding the pathogenesis of alco- holic liver disease may lead to novel future treatment approaches, including inhibition of tumor necrosis factor α antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.

Original languageEnglish (US)
Pages (from-to)1021-1029
Number of pages9
JournalMayo Clinic proceedings
Volume76
Issue number10
DOIs
StatePublished - Jan 1 2001

Keywords

  • ALT = alanine aminotransferase
  • AST = aspartate aminotransferase
  • CAGE = alcoholism screening tool containing 4 structured questions
  • DF = discriminant function
  • GI = gastrointestinal
  • MCV = mean corpuscular volume
  • NF-κB = nuclear factor κB
  • TNF = tumor necrosis factor

ASJC Scopus subject areas

  • Medicine(all)

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