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Treatment of alcoholic liver disease

INTRODUCTION

There are at present 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 in patients with alcoholic liver disease. Abstinence is also critical for those patients with advanced disease who may eventually require liver transplantation; in this setting, continued drinking will remove the patient from consideration. Referral to a rehabilitation program is usually necessary in combination with family support and counseling. (See "Liver transplantation in alcoholic liver disease".)

PREVENTION

Abstinence is the most effective means to prevent alcohol-related liver injury. In addition, several drugs have been studied to improve rates of abstinence but none is used routinely.

Abstinence — Abstinence can be beneficial even in patients with advanced histologic and clinical features. Improvement in fibrosis [1-3], a reduction in or even normalization of the portal pressure [4], and resolution (or easier treatment) of ascites [5] have accompanied alcohol abstinence in some patients.

Pharmacotherapy — Multiple drugs have been evaluated for treatment of alcohol abuse and dependence and some have been approved for use as adjunctive therapy.

PREDICTORS OF PROGNOSIS

Several prognostic factors have been identified in patients diagnosed with alcoholic liver disease. The most important variables associated with a poor prognosis are continued alcohol consumption and histologic findings, particularly the presence of hepatic inflammation.
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