A review article published in the New England Journal of Medicine discusses the effects of alcohol use on various forms of liver disease, as well as the assessment and treatment of alcohol use in patients with the chronic liver disease.

Liver-related mortality is increasing worldwide, due in large part to the increase in alcohol consumption. This review is very timely, as recent epidemiological studies have shown that alcohol consumption that does not reach the risky range is associated with increased morbidity and mortality.

Liver disease (also called hepatic disease) is a broad term describing any single number of diseases affecting the liver. Many are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile.

The mechanism behind this is not completely understood. 80% of alcohol passes through the liver to be detoxified. Chronic consumption of alcohol results in the secretion of pro-inflammatory cytokines (TNF-alpha, Interleukin 6 [IL6] and Interleukin 8 [IL8]), oxidative stress, lipid peroxidation, and acetaldehyde toxicity.

These factors cause inflammation, apoptosis and eventually fibrosis of liver cells. Why this occurs in only a few individuals is still unclear. Additionally, the liver has a tremendous capacity to regenerate and even when 75% of hepatocytes are dead; it continues to function as normal.

Below is a summary of the review article:

Alcohol use is common among patients with liver disease and is associated with poor outcomes. Also, the advanced liver disease can complicate the pharmacologic treatment of alcohol use disorder and alcohol withdrawal syndrome.

Medications approved for the alcohol use disorder are prescribed to a minority of patients, yet patients with the chronic liver disease could use them. Given that there is no safe threshold for alcohol consumption and, if it exists, it is likely shallow, abstinence should be encouraged in patients with the chronic liver disease.

Also, liver transplantation could be considered for patients who abstain from alcohol and present with progressive liver failure. The authors conclude that alcohol use disorder treatment should be expanded in everyday clinical practice to include patients with the advanced liver disease.