Prognosis and management of alcoholic fatty liver disease and alcoholic cirrhosis
- Scott L Friedman, MD
Scott L Friedman, MD
- Fishberg Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Keith D Lindor, MD
Keith D Lindor, MD
- Section Editor — Alcoholic and Metabolic Liver Disease
- Professor of Medicine, Mayo Clinic College of Medicine
- Dean, College of Health Solutions
- Arizona State University
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Excessive alcohol consumption is associated with a range of hepatic manifestations, including alcoholic fatty liver disease (with or without steatohepatitis), acute alcoholic hepatitis, and cirrhosis. Patients with an alcohol intake of 30 or more grams per day (one standard drink contains 14 grams of alcohol (figure 1)) are at increased risk of cirrhosis, although the majority of patients will not develop cirrhosis despite heavy alcohol intake (point prevalence of 1 percent for those who drink 30 to 60 g/day and 6 percent for those who drink 120 g/day) [1,2].
There are few specific therapies available for patients with alcoholic liver disease. There is, however, one extremely important intervention, abstinence, since continued alcohol ingestion is the single most important risk factor for progression of the disease . Abstinence is also critical for those patients with cirrhosis to decrease the risk of complications. In addition, patients must be abstinent in order to be listed for liver transplantation. Referral to an alcohol rehabilitation program is usually necessary in combination with family support and counseling. (See "Liver transplantation in alcoholic liver disease" and "Psychosocial treatment of alcohol use disorder" and "Pharmacotherapy for alcohol use disorder".)
This topic will review the prognosis and general management of alcoholic fatty liver disease and alcoholic cirrhosis. The clinical manifestations and diagnosis of alcoholic liver disease, the management of the complications of cirrhosis, the pathogenesis of alcoholic liver disease, and the approach to patients with acute alcoholic hepatitis are discussed separately. (See "Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis" and "Cirrhosis in adults: Overview of complications, general management, and prognosis" and "Pathogenesis of alcoholic liver disease" and "Alcoholic hepatitis: Clinical manifestations and diagnosis" and "Alcoholic hepatitis: Natural history and management" and "Liver transplantation in alcoholic liver disease".)
In 2010, the American Association for the Study of Liver Diseases and the American College of Gastroenterology issued a joint guideline for the management of patients with alcoholic liver disease . Another guideline was published in 2012 by the European Association for the Study of the Liver . The discussion that follows is generally consistent with these guidelines.
NATURAL HISTORY AND PROGNOSTIC FACTORS
Alcohol abuse may lead to steatosis, steatohepatitis, cirrhosis, and hepatocellular carcinoma. Not all patients who drink heavily develop alcoholic liver disease. However, once alcoholic liver disease develops, continued alcohol use typically leads to persistent and often progressive liver disease [6,7]. (See "Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis", section on 'Natural history'.)
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- NATURAL HISTORY AND PROGNOSTIC FACTORS
- General approach
- Nutritional therapy
- Alcoholic hepatitis
- Complications of cirrhosis
- Liver transplantation
- EXPERIMENTAL THERAPIES
- Complementary medicine
- SUMMARY AND RECOMMENDATIONS