US Gastroenterology & Hepatology Review, 2009;5:44-48
Abstract
Alcohol consumption is a major source of chronic liver disease in the western world. Currently, approximately two million people are suspected to have alcoholic liver disease (ALD). ALD encompasses a broad spectrum including fatty liver (steatosis), alcoholic hepatitis, and cirrhosis. This classification is often fluid, with these three stages often co-existing. While fatty liver is reversible with alcohol cessation, alcoholic hepatitis and cirrhosis can have a potentially more severe prognosis. This article will discuss the history, pathogenesis, diagnosis, prognosis, and treatment of ALD while highlighting recent advances in each of these areas.
Keywords
Alcohol, alcoholic hepatitis, cirrhosis, fatty liver
Disclosure
The authors have no conflicts of interest to declare.
Received:
July 07, 2009 Accepted
July 15, 2009
Correspondence:
Vijay H Shah, MD, Mayo Clinic, 200 First ST SW, Rochester, MN 55905. E: shah.vijay@mayo.edu
Because chronic alcohol consumption is the most common cause of liver cirrhosis, it is beneficial to briefly examine patterns of alcohol use and abuse. In the US, 67.3% of the population over 18 years of age drinks alcohol each year, with 7.4% of the population meeting diagnostic criteria for alcohol abuse.1 In addition to detrimental health effects, alcohol abuse costs the US government a substantial amount of money each year. In 1998 alone, healthcare costs from alcohol abuse in the US were $26.5 billion. Analysis of the global burden of alcohol abuse has prompted researchers to investigate alcohol and disease according to age, gender, socioeconomic status, and race.
Although alcoholism is more common in men, women are much more susceptible to the toxic effects of alcohol. It is thought that consumption of 80g of alcohol in men for an extended period of time can lead to alcoholic liver disease (ALD), whereas in women only 20g of alcohol can cause the same effects. This difference can be attributed t a couple of factors. Most often, women have a smaller mass than men. In addition, many women have a decreased amount of the enzyme alcohol dehydrogenase (ADH), increasing the toxic effects of alcohol on the liver.2 Therefore, if a man and woman of the same body mass consume the same amount of alcohol, the blood alcohol content in the woman’s bloodstream may be higher, leading to greater toxicity. Recent evidence has shown that estrogen may increase the susceptibility of the liver to alcohol-related damage, rendering women more vulnerable to its toxic effects.2 Therefore, myriad factors may explain why women are more susceptible to alcoholic cirrhosis than men. However, while women have a greater predisposition to developing ALD, the mortality rate in men with ALD is two-fold that of women. This reflects the tendency of men to consume a higher quantity of alcohol than women. Additionally, the majority of alcoholics are men.
In addition to gender differences, ALD varies between age groups. Cirrhosis mortality rates are very low in the younger population, but rise with increasing age. In fact, the rate of cirrhosis among people 75–84 years of age is as high as 31.1 per 100,000 individuals.2 A possible explanation for this increase in mortality associated with older age is that the natural course or progression of liver disease and cirrhosis usually worsens over time. In addition, this older group of patients has most likely been consuming alcohol for a greater length of time, increasing the chance of developing cirrhosis. Although the prevalence of cirrhosis is greatest within an older population subset, a recent study has shown that the contribution of cirrhosis to total deaths peaks between 45 and 54 years of age, becoming the fourth leading cause of death in the US within this age group.2
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