Management strategies in alcoholic liver disease

Alcoholic liver disease (ALD) and its complications is still one of the most frequent causes of death in the Western world. Treatment modalities for both alcoholic steatohepatitis (ASH; the major inflammatory complication of ALD) and alcoholic liver cirrhosis are insufficient. Severe ASH is associated with a high mortality; although glucocorticoid treatment has been reported to improve survival, meta-analyses of clinical trials performed to date have failed to show a convincing benefit of such an approach. Most of the progress in understanding these diseases, especially ASH, has come from studies of cytokines. Various proinflammatory cytokines, such as tumor necrosis factor (TNF), have been proposed to have an important role in the pathophysiology of ALD and its complications. Pilot studies on the use of anti-TNF drugs, such as pentoxifylline or infliximab, in the treatment of ASH have now been performed with various levels of success. The treatment of patients with alcohol-related cirrhosis is mainly symptomatic and no therapies are currently available except orthotopic liver transplantation for end-stage liver disease. Independent of the stage of disease, abstinence from alcohol is the cornerstone of management. New treatment modalities for these diseases are eagerly awaited.