Diagnosis and therapy of alcoholic liver disease

Josh Levitsky, Mark E. Mailliard*

*Corresponding author for this work

Research output: Contribution to journalReview article

83 Citations (Scopus)

Abstract

Alcoholic liver disease (ALD) presents considerable challenges to clinicians. Screening for alcohol abuse and alcoholism should be routine and repeated annually with close attention to signs and symptoms of liver disease. In patients with evidence of liver dysfunction or injury, consideration should be given to performance of liver biopsy for diagnosis and prognosis and prior to initiation of medication with the potential for significant side effects. Therapy depends on the spectrum of pathological liver injury: alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. Abstention is the foundation of therapy for an alcohol problem. Alcoholic fatty liver should improve with abstention, but the similarity to the pathogenesis of nonalcoholic fatty liver and potential for progressive injury merits consideration of lipotropic agents. The continuing mortality, poor acceptance of corticosteroids, and identification of tumor necrosis factor-alpha (TNF-α) as an integral component has led to studies of pentoxifylline and, recently, anti-TNF antibody to neutralize cytokines in the therapy of severe alcoholic hepatitis. Antioxidant therapy of alcoholic cirrhosis has significant promise but will require large clinical trials.

Original languageEnglish (US)
Pages (from-to)233-247
Number of pages15
JournalSeminars in Liver Disease
Volume24
Issue number3
DOIs
StatePublished - Aug 1 2004

Fingerprint

Alcoholic Liver Diseases
Alcoholic Fatty Liver
Alcoholic Hepatitis
Alcoholic Liver Cirrhosis
Alcoholism
Liver Diseases
Wounds and Injuries
Lipotropic Agents
Pentoxifylline
Liver
Therapeutics
Signs and Symptoms
Anti-Idiotypic Antibodies
Adrenal Cortex Hormones
Tumor Necrosis Factor-alpha
Antioxidants
Alcohols
Clinical Trials
Cytokines
Biopsy

Keywords

  • Alcoholic
  • Antibodies
  • Corticosteroids
  • Liver disease
  • Monoclonal
  • Tumor necrosis factor-alpha

ASJC Scopus subject areas

  • Hepatology

Cite this

Levitsky, Josh ; Mailliard, Mark E. / Diagnosis and therapy of alcoholic liver disease. In: Seminars in Liver Disease. 2004 ; Vol. 24, No. 3. pp. 233-247.
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Diagnosis and therapy of alcoholic liver disease. / Levitsky, Josh; Mailliard, Mark E.

In: Seminars in Liver Disease, Vol. 24, No. 3, 01.08.2004, p. 233-247.

Research output: Contribution to journalReview article

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AU - Mailliard, Mark E.

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AB - Alcoholic liver disease (ALD) presents considerable challenges to clinicians. Screening for alcohol abuse and alcoholism should be routine and repeated annually with close attention to signs and symptoms of liver disease. In patients with evidence of liver dysfunction or injury, consideration should be given to performance of liver biopsy for diagnosis and prognosis and prior to initiation of medication with the potential for significant side effects. Therapy depends on the spectrum of pathological liver injury: alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. Abstention is the foundation of therapy for an alcohol problem. Alcoholic fatty liver should improve with abstention, but the similarity to the pathogenesis of nonalcoholic fatty liver and potential for progressive injury merits consideration of lipotropic agents. The continuing mortality, poor acceptance of corticosteroids, and identification of tumor necrosis factor-alpha (TNF-α) as an integral component has led to studies of pentoxifylline and, recently, anti-TNF antibody to neutralize cytokines in the therapy of severe alcoholic hepatitis. Antioxidant therapy of alcoholic cirrhosis has significant promise but will require large clinical trials.

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