Alcoholic Liver Disease: Evaluation of Natural History and Prognostic Factors

✍ Scribed by Steven Schenker

• Publisher: John Wiley and Sons
• Year: 1984
• Tongue: English
• Weight: 874 KB
• Volume: 4
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840040712

✦ Synopsis

Alcoholic liver disease, i.e., hepatic dysfunction developing in individuals abusing ethanol and caused by it, is worldwide in distribution and affects adults of both sexes and all ages. Alcohol abuse may cause a wide spectrum of hepatic changes. In most individuals, it may result in fat accumulation in the liver with or without overt functional changes, but often with a change in various aspects of hepatic metabolism (i.e., induction of drug metabolism, changes in glucose homeostasis, etc.). In others, it may lead to alcoholic hepatitis and/or cirrhosis, usually with varying disturbances in hepatic function (1).

It is well established that the incidence of alcoholic cirrhosis and mortality from it are generally correlated with the amount and duration of ethanol abuse (1, 2). Still, despite the high incidence of alcoholism throughout the world, the incidence of cirrhosis in this population is low. In autopsy series, it seems to vary from 8.7 to 18% and in studies based on liver biopsy it ranges from 12 to 31% (2). Thus, with about 10 to 12 million alcoholics in the United States, one may project over a period of time about 1 to 2 million patients with alcoholic cirrhosis. Since many alcoholics do not develop overt cirrhosis but remain at the stage of fatty liver and/or alcoholic hepatitis (3), the prevalence of these hepatic lesions among ethanol abusers is bound to be much higher than overt cirrhosis. The validity of such estimates will depend obviously on the reliability of determining the incidence of alcohol abuse in a population (a well-known problem), on the amounts and duration of ethanol consumption and the impact on this of recent educational campaigns, cost of liquor, and other economic factors, on the development of new treatment modalities and other imponderables. Among the latter unknown factors may be the