Alcohol-Related Liver Diseases

By Ehrmann, Jiří; Urban, Ondřej et al. | Central European Journal of Public Health, December 2019 | Go to article overview

Alcohol-Related Liver Diseases


Ehrmann, Jiří, Urban, Ondřej, Dvoran, Pavol, Central European Journal of Public Health


INTRODUCTION

Medical authorities and laymen alike have considered, or even still consider, extensive alcohol drinking to be primarily associated with liver damage. After all, one third or even a half of liver diseases originate due to alcohol abuse, and 'hardening of the liver' is the feared liver disease of excessive drinkers. However, since the first scientific interest in the influence of alcohol on health attention was also paid to ailments other than those of the liver, irrespective of psychosocial aspects, as follows from constituent articles of the Journal of Studies on Alcohol and Drugs supplement which was written on the 75-year anniversary of the journal's origin (1). In fact, interest in alcohol-related liver disease increased in connection with a hot medicine topic - non-alcoholic fatty liver disease (NAFLD). Even though the aetiopathogenesis of these diseases is different, histological and clinical pictures are similar, including unfavourable consequences. This was one of the reasons why the European Association for the Study of the Liver (EASL) worked up and issued guidelines for the management of the alcohol-related liver diseases - the EASL Clinical Practice Guidelines: Management of Alcohol-Related Liver Disease - and published them in the Journal of Hepatology (2). In this article, these guidelines are taken into consideration.

History

The association between alcohol drinking and liver cirrhosis development was first described by Matthew Bailie in 1793. Later, Thomas Addison described fatty liver degeneration - steatosis - as a consequence of excessive alcohol consumption. In 1819 René Théophile Laennec coined the term liver cirrhosis. Today the terms Laennec's cirrhosis or portal cirrhosis are not used, but formerly they were used to name cirrhosis of alcoholic or viral origin. In 1842 William Bowman determined histological criteria for liver steatosis, which is the most common liver disease related to alcohol (3). Scientifically supported knowledge about the unfavourable effects of alcohol on human health has its origin in the Department of Applicated Physiology, Yale University (USA). In 1940 this institution began to publish the Quarterly Journal of Studies on Alcohol, today named the Journal of Studies on Alcohol and Drugs. In the first number of this journal, K. M. Jellinek and N. Joliffe presented an analysis of all works about alcohol effects on health that had previously been published. Even though direct alcohol damage of the liver was supposed, the nutrition status, addiction development, genetic and other influences were considered to be the key factors in the aetiopathogenesis of liver damage. The key study, which proved the causal importance of alcohol in alcoholic liver fibrosis, was published by Mak et al. The authors observed lipocyte (Ito's cells) ultrastructure through baboon liver autopsies, and its change into fibrosis caused by a many-year diet in which alcohol took up half of the energetic input, against a second control group in which alcohol was not present. This work was announced to be one of the milestone publications of the 20th century by the Journal of Hepatology (EASL press organ) (4, 5).

Terminology

In recent years, alcoholic liver disease (ALD) terminology has been much discussed. Psychiatricians and psychologists object that existing terminology may stigmatise patients who suffer from alcohol overuse, but are not addicted, i.e they are not alcoholics. The recommended new terminology is shown in Table 1. It is not an academic formal terminology innovation. The issue is that it is a recommendation with an impact on the strategy of management of alcohol-related liver damage.

Epidemiology of ALD

ALD develops in consumers of more than two drinks per day (EASL recommends considering one drink as containing 10 g of alcohol). Most of these consumers suffer from greater or smaller hepatomegaly due to steatosis, a benign state which is reversible after 6-8 weeks of abstinence. …

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