Pathophysiology and Management of Alcoholic Liver Disease: Update 2016

• Published in: Gut and liver Vol. 11; no. 2; pp. 173 - 188
• Main Authors: Stickel, Felix, Datz, Christian, Hampe, Jochen, Bataller, Ramon
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 15.03.2017; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Adrenal Cortex Hormones - therapeutic use; Alcohol Drinking - adverse effects; alcoholic; carcinoma; corticosteroid therapy; Disease Management; Europe; hepatitis; hepatocellular; Humans; Liver Cirrhosis, Alcoholic - etiology; Liver Cirrhosis, Alcoholic - physiopathology; Liver Cirrhosis, Alcoholic - therapy; Liver Diseases, Alcoholic - complications; Liver Diseases, Alcoholic - etiology; Liver Diseases, Alcoholic - physiopathology; Liver Diseases, Alcoholic - therapy; Liver Transplantation; malnutrition; pnpla3; Review; 내과학; Carcinoma, hepatocellular; PNPLA3; Hepatitis, alcoholic; Corticosteroid therapy; Malnutrition; Liver transplantation
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl16477

Alcoholic liver disease (ALD) is a leading cause of cirrhosis, liver cancer, and acute and chronic liver failure and as such causes significant morbidity and mortality. While alcohol consumption is slightly decreasing in several European countries, it is rising in others and remains high in many countries around the world. The pathophysiology of ALD is still incompletely understood but relates largely to the direct toxic effects of alcohol and its main intermediate, acetaldehyde. Recently, novel putative mechanisms have been identified in systematic scans covering the entire human genome and raise new hypotheses on previously unknown pathways. The latter also identify host genetic risk factors for significant liver injury, which may help design prognostic risk scores. The diagnosis of ALD is relatively easy with a panel of well-evaluated tests and only rarely requires a liver biopsy. Treatment of ALD is difficult and grounded in abstinence as the pivotal therapeutic goal; once cirrhosis is established, treatment largely resembles that of other etiologies of advanced liver damage. Liver transplantation is a sound option for carefully selected patients with cirrhosis and alcoholic hepatitis because relapse rates are low and prognosis is comparable to other etiologies. Still, many countries are restrictive in allocating donor livers for ALD patients. Overall, few therapeutic options exist for severe ALD. However, there is good evidence of benefit for only corticosteroids in severe alcoholic hepatitis, while most other efforts are of limited efficacy. Considering the immense burden of ALD worldwide, efforts of medical professionals and industry partners to develop targeted therapies in ALF has been disappointingly low.