Portal fibrosis in the livers of alcoholic patients

Liver biopsies in nine of 70 male alcoholics seen during a 12 month period showed predominantly portal fibrosis with fatty change, but little or no alcoholic hepatitis. None of the 30 female alcoholics seen during the same period showed this appearance. The nine men were younger and of lower socioeconomic class than the other male alcoholics, but had similar alcoholic history. Seven of the nine had chronic pancreatitis, diagnosed in six patients on the results of the pancreatic scan, Lundh meal and endoscopic retrograde pancreatography and in one because of pancreatic calcification and steatorrhoea. Serum tests for hepatitis B surface antigen were negative but five showed hepatitis B antibody. Four had serological evidence of previously treated or active syphilis compared with only one of the remaining 61 male alcoholics. Two had pulmonary tuberculosis and both had received isoniazid. Four of the other 61 alcoholics gave a history of tuberculosis similarly treated. At least one cause for the portal fibrosis other than primary alcoholic liver disease was found in all nine patients. Portal fibrosis in an alcoholic in the absence of severe alcoholic hepatitis should lead to a search for other causal factors. In particular, chronic pancreatitis should be excluded even if the patient is asymptomatic.