Alcoholism and Liver Disease-Reply

Abstract

In Reply.— Our prospective study was not designed to evaluate every possible combination of alcoholic and non-alcoholic liver disease. Consequently, some clinicians may think we have excluded critically important groups, ie, groups they would have included. Drs Boyer and Levin are concerned that we did not include a group of alcoholics with biopsy-verified nonalcoholic liver disease in our analysis. We have, in fact, seen six such patients who admitted to consuming a minimum of four to six drinks per day during the six months preceding their biopsy-based diagnosis of nonalcoholic liver disease. All six patients were classified as having alcoholic liver disease on the basis of the discriminant analysis, indicating that when liver-damaged patients consume relatively large amounts of alcohol, the resulting biochemical and hematologic alterations resemble those observed in patients with biopsy-verified alcoholic liver disease. This explanation is supported by the subsequent observation that when two of the six