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Alcoholic and Non-Alcoholic Fatty Liver Disease pp 165–182Cite as

Clinical Features, Disease Modifiers, and Natural History of Alcoholic Liver Disease

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Abstract

Alcoholic liver disease (ALD) is a major cause of morbidity and mortality worldwide. The clinical spectrum of ALD includes fatty liver, steatohepatitis with or without fibrosis, and cirrhosis. The diagnosis of ALD is made in patients with evidence of liver injury based on clinical history, physical findings, and laboratory abnormalities, when there is evidence of significant alcohol consumption and after other causes of chronic liver disease have been excluded. Signs and symptoms may be essentially nonexistent in steatosis or possibly mild fatigue and abdominal discomfort. On the other hand, those with decompensated disease may present with massive ascites, muscle wasting, gastrointestinal bleeding, and encephalopathy. Many people drink heavily, yet only a limited number (~35 %) develop more advanced liver diseases (alcoholic hepatitis or cirrhosis). Thus, there must be modifying factors that either prevent or facilitate disease activity/progression. These modifiers can either be fixed (e.g., genetic) or can undergo intervention (e.g., continued drinking, smoking, diet). We review ten disease modifiers of particular importance to ALD. Patients with steatosis only may “normalize” with cessation of drinking; however, outcomes are highly variable once the patient has progressed to cirrhosis. Some subjects die quickly with acute-on-chronic liver disease; other patients who abstain from alcohol and correct other disease modifiers may live a relatively normal life; others may do well for long periods of time only to expire from hepatocellular carcinoma. The biggest variable is continued drinking, and cessation of this and modification of other disease modifiers such as smoking should be aggressively pursued.

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Acknowledgments

This work was supported by NIH grants, R01AA018869 (CJM), U01AA021893 (CJM), U01AA021901 (CJM), R01AA023681 (CJM), U01AA022489 (CJM), and the Veterans Administration (CJM).

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 505 South Hancock Street, Louisville, KY, 40292, USA

    Luis S. Marsano M.D., Vatsalya Vatsalya M.D., Ammar Hassan M.D. & Craig J. McClain M.D.

  2. Department of Medicine, University of Louisville, 550 South Jackson Street, 3rd Floor, Louisville, KY, 40292, USA

    Luis S. Marsano M.D., Vatsalya Vatsalya M.D., Ammar Hassan M.D. & Craig J. McClain M.D.

  3. Robley Rex Veterans Affairs Medical Center, Louisville, KY, 40207, USA

    Luis S. Marsano M.D. & Craig J. McClain M.D.

  4. Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY, 40202, USA

    Craig J. McClain M.D.

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  1. Luis S. Marsano M.D.
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  2. Vatsalya Vatsalya M.D.
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Correspondence to Craig J. McClain M.D. .

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  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Naga Chalasani

  2. Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

    Gyongyi Szabo

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Marsano, L.S., Vatsalya, V., Hassan, A., McClain, C.J. (2016). Clinical Features, Disease Modifiers, and Natural History of Alcoholic Liver Disease. In: Chalasani, N., Szabo, G. (eds) Alcoholic and Non-Alcoholic Fatty Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-20538-0_8

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