Liver damage: mechanisms and management

Despite recent advances in our knowledge of the mechanisms of alcohol-induced liver damage, abstinence from alcohol and supportive measures remain the mainstays of management for the majority of patients. Progress has been made in our understanding of ethanol metabolism, the role of acetaldehyde, and both genetic and environmental factors responsible for the variation in individual susceptibility to alcoholic liver disease. Evidence for the involvement of the immune system and the effects of alcohol on hepatic fibrosis are also reviewed. Recent therapeutic trials of corticosteroids in acute alcoholic hepatitis have confirmed their benefit in patients who have a high risk of mortality. For patients with end-stage cirrhosis, orthotopic liver transplantation is now an accepted therapy in selected patients who have a good prognosis for future abstinence.