Diagnosis and management of alcoholic liver disease.

Alcohol is the most commonly used hepatotoxin worldwide. About 90% of heavy drinkers (more than 60 g/day of alcohol) show evidence of fatty livers, while only 10-35% develop alcoholic hepatitis and 5-15% developed cirrhosis. The daily intake of alcohol that results in liver injury varies and depends on a number of risk factors. Alcoholic disease developes at lower doses in females, Hispanic, obese objects, and patients with hepatitis C. Insights into the pathogenesis of alcohol-induced liver injury has improved significantly but the translation into clinical benefit has been slow. The importance of continued abstinence and correction of nutritional deficiencies are major components in the long-term management of liver disease. Alcohol hepatitis has a variable mortality and the prognosis is determined most commonly by the modified discriminant function. The mocel of end-stage liver disease (MELD) is being increasingly used to predict outcome in alcoholic hepatitis even though standard cut offs are not available. Anti-inflammatory therapy with corticosteroids and anticytokine therapy with corticosteroids and pentoxifylline are effective for patients with severe alcoholic hepatitis. Patients with endstage liver disease should be considered for liver transplantation. Six months of abstinence is considered to be a requirement prior to transplant, but this length of time may be adjusted in individual bases.