Alcoholic liver disease (ALD) is the most widespread form of chronic liver disease that progresses from alcoholic steatosis/fatty liver (AFL) to alcoholic steatohepatitis (ASH). Heavy, and prolonged binge type of alcohol drinking would generally lead to AFL that develops into fibrosis and further manifests as clinically significant conditions namely alcoholic cirrhosis (AC, as a late stage ALD) and infrequently to hepatocellular carcinoma (HCC). Acutely progressed form of ALD is identified as alcoholic hepatitis (AH) that shows rapid development of liver pathology, immune dysregulation and exhibits high mortality as prognosis. Acute-on-chronic liver failure (ACLF - an advanced form of ALD) is observed in patients who exhibit acute decompensation along with underlying AC. ALD patients are often diagnosed at progressed and severe stages and very few studies have characterized early onset of ALD. Diagnosis of ALD requires thorough documentation of chronic heavy alcohol intake, and differential diagnosis to rule out other forms of liver condition. Progression of AFL into different liver conditions involves the interplay of several pathways that could precede/overlap each other at different stages and conditions. Multiple pathological pathways are involved in progression and severity of ALD. Predominant mechanisms involved in the ALD pathology are oxidative stress, dysregulated metabolism of nutritional constituents and malnutrition, genetics and epigenetics factors, ER stress, gut permeability and gut-derived liver toxicity and inflammation. Medical management of severe and progressed form of ALD includes treatment associated with complications, reduction of alcohol withdrawal syndrome, prevention and treatment of infections, nutritional supplementation, and strategies for lowering of alcohol consumption. With no specific treatment approved by the FDA for any stage of ALD, extended abstinence from alcohol has so far been the best interventional strategy to prevent disease progression.
KeywordsAlcohol Alcohol dehydrogenase Alcoholic liver disease Alcoholic cirrhosis Alcoholic hepatitis Epigenetics Genetics Gut-derived liver injury Malnutrition Oxidative stress
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