Influence of ethanol on development of hyperplastic nodules in alcoholic men with micronodular cirrhosis

The type of cirrhosis was blindly evaluated in follow-up liver biopsies performed on 106 alcoholic men with micronodular cirrhosis. The median time interval from entry to follow-up liver biopsy was 31 mo (range, 3-44 mo). Patients were stratified into four groups according to their maximal registered ethanol consumption during follow-up. Thirty-six patients (34%) abstained from ethanol, 40 patients (38%) consumed a small amount of ethanol (less than 50 g/day), 19 patients (18%) consumed a moderate amount of ethanol (51-100 g/day), and 11 patients (10%) consumed an excessive amount of ethanol (greater than 100 g/day) during follow-up. Follow-up liver biopsy specimens demonstrated micronodular cirrhosis in 54 patients (51%), micronodular cirrhosis with development of hyperplastic nodules in 47 patients (44%), and nonclassifiable macronodular cirrhosis in 4 patients (4%); 1 patient showed portal fibrosis. The cumulative prevalence of patients developing hyperplastic nodules increased significantly (p = 0.014 for trend) with decreasing ethanol consumption, the prevalence being 57% in abstainers, 58% in those who consumed a small amount of ethanol, 32% in those who consumed a moderate amount, and 18% in those who consumed an excessive amount. In conclusion, alcoholic men with micronodular cirrhosis develop hyperplastic nodules during follow-up, the rate and prevalence of which is significantly related to the amount of ethanol consumed during follow-up. Ethanol consumption may inhibit hepatocellular proliferation in alcoholic men with micronodular cirrhosis.