Alcoholic liver disease (ALD)

Alcoholic liver disease remains in Europe the most common cause of subclinical abnormalities of laboratory tests and the most common indication for liver transplantation for terminal cirrhosis. Consecutive stages of this disease are simple steatosis, alcoholic steatohepatitis and cirrhosis, which develops in less than 10% of heavy drinkers. Occasionally, steatohepatitis may aggravate to liver failure with full metabolic decompensation. The most important steps in pathogenesis of acute steatohepatitis are cellular oxidative stress and hepatic exposure to gut endotoxins. Hepatic toxicity to alcohol and severity of liver damage are individual features, associated with poorly recognized genetic predisposition and comorbid factors such as infection with HCV, malnutrition, obesity, diabetes, haemosiderosis or hepatotoxic drugs. The mainstay of therapy remains relentless abstinence from alcohol, which improves the clinical outcome of all stages of alcoholic liver disease. A diet rich in calories and vitamins has a supportive therapeutic role, and standard management in patients with severe steatohepatitis is use of corticosteroids, having a beneficial effect on short-term survival.