Review
Alcoholic liver disease
Kevin Walsh, Graeme Alexander
Department of
Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital,
Cambridge CB2 2QQ, UK
Correspondence to: Dr Alexander
Submitted 3 June 1999;
Accepted 6 September 1999
Alcohol is a major cause of liver cirrhosis in the
Western world and accounts for the majority of cases of liver cirrhosis seen in district general hospitals in the UK. The three most widely recognised forms of alcoholic liver disease are alcoholic fatty liver
(steatosis), acute alcoholic hepatitis, and alcoholic cirrhosis. The
exact pathogenesis of alcoholic liver injury is still not clear but
immune mediated and free radical hepatic injury are thought to be
important. There is increasing interest in genetic factors predisposing
to hepatic injury in susceptible individuals. Diagnosis is based on
accurate history, raised serum markers such as
-glutamyltransferase, mean corpuscular volume, and IgA and liver
histology when obtainable. Abstinence is the most important aspect of treatment. Newer drugs such as acamprosate and naltrexone are
used to reduce alcohol craving. Vitamin supplements and nutrition are
vital while corticosteroids have a role in acute alcoholic hepatitis
where there is no evidence of gastrointestinal haemorrhage or
sepsis. Liver transplantation has excellent results in abstinent patients with end stage liver disease but there are concerns about recidivism after transplant.
Keywords: cirrhosis; liver disease; alcohol
© 2000 by The Fellowship of Postgraduate Medicine
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