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Alcoholic liver disease

Nature Reviews Disease Primers volume 4, Article number: 16 (2018) Cite this article

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A Publisher Correction to this article was published on 28 August 2018

This article has been updated

Abstract

Alcoholic liver disease (ALD) is the most prevalent type of chronic liver disease worldwide. ALD can progress from alcoholic fatty liver (AFL) to alcoholic steatohepatitis (ASH), which is characterized by hepatic inflammation. Chronic ASH can eventually lead to fibrosis and cirrhosis and in some cases hepatocellular cancer (HCC). In addition, severe ASH (with or without cirrhosis) can lead to alcoholic hepatitis, which is an acute clinical presentation of ALD that is associated with liver failure and high mortality. Most individuals consuming >40 g of alcohol per day develop AFL; however, only a subset of individuals will develop more advanced disease. Genetic, epigenetic and non-genetic factors might explain the considerable interindividual variation in ALD phenotype. The pathogenesis of ALD includes hepatic steatosis, oxidative stress, acetaldehyde-mediated toxicity and cytokine and chemokine-induced inflammation. Diagnosis of ALD involves assessing patients for alcohol use disorder and signs of advanced liver disease. The degree of AFL and liver fibrosis can be determined by ultrasonography, transient elastography, MRI, measurement of serum biomarkers and liver biopsy histology. Alcohol abstinence achieved by psychosomatic intervention is the best treatment for all stages of ALD. In the case of advanced disease such as cirrhosis or HCC, liver transplantation may be required. Thus, new therapies are urgently needed.

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Fig. 1: The natural disease course of alcoholic liver disease.
Fig. 2: Global total alcohol per capita consumption.
Fig. 3: Metabolic pathways related to alcohol.
Fig. 4: Mechanisms involved in alcoholic fatty liver.
Fig. 5: Mechanisms involved in alcoholic liver inflammation.
Fig. 6: Mechanisms involved in alcoholic liver fibrosis.
Fig. 7: Mechanisms of alcohol-mediated liver tumour initiation and promotion.
Fig. 8: Clinical interpretation of liver stiffness in alcoholic liver disease.
Fig. 9: Liver biopsy diagnosis of alcoholic liver disease.

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Acknowledgements

The authors thank H. Engel for her help in managing administration, English language correction and the reference list during the writing of this article.

Reviewer information

Nature Reviews Disease Primers thanks H. Tilg, M. Neuman, A. Cederbaum, T. Morgan and R. Williams for their contribution to the peer review of this work.

Author information

Affiliations

  1. Centre of Alcohol Research (CAR),, University of Heidelberg, Heidelberg and Department of Medicine, Salem Medical Center, Heidelberg, Germany

    Helmut K. Seitz & Sebastian Mueller

  2. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA

    Ramon Bataller

  3. Departmento de Gastroenterologia, CHLN, Laboratorio de Nutricão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Helena Cortez-Pinto

  4. Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA

    Bin Gao

  5. Addiction Unit, Neuroscience Institute Hospital Clinic, IDIBAPS, Barcelona, Spain

    Antoni Gual

  6. Institute of Pathology, Medical University of Graz, Graz, Austria

    Carolin Lackner

  7. Service des Maladies de l’Appareil Digestif, Universite Lille 2 and INSERM U795, Lille, France

    Philippe Mathurin

  8. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Gyongyi Szabo

  9. University of Southern California Keck School of Medicine and Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA

    Hidekazu Tsukamoto

Authors
  1. Helmut K. Seitz
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  2. Ramon Bataller
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  3. Helena Cortez-Pinto
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  4. Bin Gao
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  5. Antoni Gual
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  6. Carolin Lackner
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  7. Philippe Mathurin
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  8. Sebastian Mueller
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  9. Gyongyi Szabo
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  10. Hidekazu Tsukamoto
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Contributions

Introduction (H.K.S.); Epidemiology (H.K.S. and H.C.-P.); Mechanisms/pathophysiology (H.K.S., R.B., G.S. and H.T.); Diagnosis, screening and prevention (H.K.S., A.G., C.L. and S.M.); Management (R.B., A.G. and P.M.); Quality of life (H.C.-P.); Outlook (R.B. and B.G.); Overview of Primer (H.K.S.).

Corresponding author

Correspondence to Helmut K. Seitz.

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Competing interests

H.K.S. has received lecture fees from the Falk Foundation and research grants from Octapharma. R.B. has no conflicts of interest. H.C.-P. has received lecture fees and advisory board fees from Genfit, Gilead Sciences, Intercept Pharmaceuticals and Merck. She is also the Policy Councillor for the European Association for the Study of the Liver. B.G. has no conflicts of interest. A.G. has received honoraria and grants for research from D&A Pharma SAS and Lundbeck Limited. He was also principal investigator in one of the nalmefene pivotal studies, investigator in the sodium oxybate trial and Spanish coordinator of the acamprosate trial (Adisa study). He is a past president of the European Federation of Addiction Societies and vice president of the International Network on Brief Interventions for Alcohol and Drugs. C.L. has no conflicts of interest. P.M. consults for Gilead Sciences and Verlyx Pharma. S.M. has previously been an adviser for Echosens. G.S. has received US NIH grant funding from the National Institute on Alcohol Abuse and Alcoholism, is employed by the University of Massachusetts Medical School and is the Editor-in-Chief of Hepatology Communications of the American Association for the Study of Liver Disease. H.T. has received grants and donations from EA Pharma, Gilead Sciences and Otsuka Pharmaceutical.

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Seitz, H.K., Bataller, R., Cortez-Pinto, H. et al. Alcoholic liver disease. Nat Rev Dis Primers 4, 16 (2018). https://doi.org/10.1038/s41572-018-0014-7

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