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

  • Luis S. Marsano
  • Vatsalya Vatsalya
  • Ammar Hassan
  • Craig J. McClainEmail author


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.


Alcoholic liver disease Alcoholic cirrhosis Alcoholic hepatitis AUDIT Hepatocellular carcinoma Heavy drinking Carbohydrate-deficient transferrin 



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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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Luis S. Marsano
    • 1
    • 2
    • 3
  • Vatsalya Vatsalya
    • 1
    • 2
  • Ammar Hassan
    • 1
    • 2
  • Craig J. McClain
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Division of Gastroenterology, Hepatology and NutritionUniversity of LouisvilleLouisvilleUSA
  2. 2.Department of MedicineUniversity of LouisvilleLouisvilleUSA
  3. 3.Robley Rex Veterans Affairs Medical CenterLouisvilleUSA
  4. 4.Department of Pharmacology & ToxicologyUniversity of Louisville School of MedicineLouisvilleUSA

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