Controversies in the management of alcoholic liver disease

Hui Hui Tan, Sharad Virmani, Paul Martin

Research output: Contribution to journalReview article

27 Scopus citations

Abstract

Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Non-responders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant.

Original languageEnglish (US)
Pages (from-to)484-498
Number of pages15
JournalMount Sinai Journal of Medicine
Volume76
Issue number5
DOIs
StatePublished - Oct 1 2009

Keywords

  • Alcohol abuse
  • Alcohol tolerance
  • Alcoholic hepatitis
  • Alcoholic liver disease
  • Liver transplant

ASJC Scopus subject areas

  • Medicine(all)

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