Alcohol and the liver

Hospital admissions due to alcohol-related liver disease (ArLD) are increasing. Both the quantity and the pattern of alcohol consumption are linked to an increased risk of ArLD. However, other factors such as obesity, coexisting liver disease – particularly hepatitis C – gender, nutritional status and genetic factors also play a role. The spectrum of ArLD ranges from steatosis to alcoholic hepatitis to established cirrhosis; a progression of liver injury which involves multiple mechanisms. Excessive alcohol consumption can cause cirrhosis in the absence of alcohol dependency syndrome. The presentation is variable, and recognition requires clinicians to be aware of the significance of a history of alcohol excess, clinical stigmata of liver disease and compatible laboratory investigations. Early detection of liver injury is key. Not all people who drink to excess develop liver disease, and other causes of liver damage must be excluded. The mainstay of management is long-term abstinence, and medical interventions should be delivered in conjunction with addiction services. Nutritional issues should also be addressed. Acute alcoholic hepatitis has a high mortality, and patients with the highest risk can benefit from short-term corticosteroids. Individuals with cirrhosis require hepatoma surveillance and variceal screening; liver transplantation should be considered in selected cases.