Current Management of Alcoholic Liver Disease
Alcoholic liver disease, including acute alcoholic hepatitis and alcoholic cirrhosis, is a major cause of morbidity and mortality in the Western world. Abstinence remains the cornerstone of management of all forms of alcoholic liver disease. Recent research, which has elucidated the mechanisms of alcohol-induced liver injury, offers the prospect of advances in the management of alcoholic liver disease. We review the most recent data on the efficacy of treatment of acute alcoholic injury, including nutritional support, corticosteroids, anti-inflammatory agents and antioxidants, and agents that are directed against the progression to fibrosis, such as colchicines, propylthiouracil and antioxidants. Although these therapies offer a tantalizing glimpse into a future that may include therapies that directly alter the process of injury and repair in the liver, none has been shown consistently to improve the course of alcoholic liver damage. Consequently, liver transplantation remains an ultimate option for selected patients with liver failure due to chronic alcoholic liver damage.

Alcohol intake remains the most important cause of cirrhosis in the Western world. The causal association between alcohol intake and the development of alcoholic liver disease has been well demonstrated. Nevertheless, it remains a conundrum that only a small proportion of heavy drinkers develop the most advanced form of the disease (liver cirrhosis). It is presumed, therefore, that other factors, such as gender, genetic background and additional environmental influences, particularly chronic viral infection, play a role in the genesis of alcoholic liver disease. The effects of both the duration and quantity of alcohol consumption on liver disease have also been studied extensively. In this review, we concentrate on therapies for alcoholic liver disease and attempt to link therapeutic options to recent advances in our understanding of the pathogenesis. We use the terms alcohol and ethanol interchangeably.