REVIEW – April 2006

Alcoholic liver disease


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Alcoholic liver disease is an increasing problem in Estonia. Screening for alcohol abuse and alcoholism should become a routine practice repeated annually with special attention to the signs and symptoms of liver disease. The pathogenesis is uncertain, but relevant factors include metabolism of alcohol into toxic products, oxidant stress, acetaldehyde adducts, action of endotoxin on Kupffer cells, and impaired hepatic regeneration. Abstinence remains the cornerstone of management of all forms of alcoholic liver disease. Supportive care is extremely necessary.
Therapy depends on the spectrum of pathological liver injury: alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. Alcoholic fatty liver should improve with abstention. Corticosteroids have been shown to be beneficial for a subset of severely ill patients. Identification of tumour necrosis factor-alpha (TNF-α) as an integral component has stimulated studies of pentoxifylline and, recently, of the effectiveness of the anti-TNF antibody to neutralize cytokines in management of severe alcoholic hepatitis.