Alcoholic liver disease. Clinical example

Abstract

Alcoholic liver disease (ALD) is one of the major liver diseases associated with high mortality rates. There are about 3 million alcohol-related deaths worldwide every year. ALD covers the spectrum of liver damage ranging from asymptomatic steatosis, alcoholic steatohepatitis and fibrosis to cirrhosis. In addition, patients may suffer from acute and chronic liver failure, alcoholic hepatitis (AH), bleeding from esophageal or gastric varices, ascites, coagulopathy, hepatic encephalopathy and liver cancer. In most patients, AH is diagnosed at advanced stages of the disease with higher complication and mortality rates. Patients abusing alcohol may simultaneously have viral hepatitis B or C, genetic diseases such as alpha-1 antitrypsin deficiency or hemochromatosis. The clinical manifestations of the disease are very diverse. There is no special laboratory test to detect the alcoholic cause of liver damage. A liver biopsy in the context of alcohol abuse in the history is a diagnostic test, but is not indicated for all patients. The main focus of therapy for ALD patients regardless of the stage of the disease is prolonged alcoholic abstinence. Abstinence is also the main key to preventing alcoholic liver diseases. Corticosteroids provide short-term survival improvement in about half of the patients with severe AH, and long-term survival is related to the severity of the underlying liver disease and depends on alcohol abstinence. General therapeutic measures in patients hospitalized with ALD include inpatient treatment of complications, treatment of alcohol withdrawal syndrome, monitoring of concomitant infectious diseases and their early effective antibiotic therapy, addition of hepatoprotectors to therapy regimens, and treatment of the underlying alcohol-related disorder. Liver transplantation (LT) is the final treatment option in patients with decompensated alcoholic liver cirrhosis. LT may also be considered in individual patients with AH who do not respond to drug therapy. Existing AH treatment regimens have insufficient efficacy, therefore, development of new methods and regimens of ALD targeted therapy is required. In this article we will consider the pathogenesis and treatment of ALD, paying more attention to AH, its topical and promising methods of treatment.