Classification and Diagnosis of Alcoholic Liver Disease
Excessive alcohol consumption often causes accumulation of fat in liver cells called steatosis. This condition is generally fully reversible as long as the patient stops drinking, however, in the presence of steatosis, excessive alcohol consumption leads to a significantly increased risk of developing hepatitis, fibrosis and cirrhosis.
Patients with cirrhosis induced by alcohol are at a significantly increased risk of developing hepatocellular carcinoma than patients with other types of cirrhosis. Patients with a fatty liver showing no signs of inflammation or fibrosis have a much lower risk of developing cirrhosis than those with a fatty liver showing signs of liver inflammation or fibrosis.
The disease that classifies patients with a fatty liver, inflammation and fibrosis due to alcohol abuse, has been defined as alcoholic steatohepatitis (ASH). However, liver histology of patients with ASH is rather similar to that experienced by patients with nonalcoholic steatohepatitis (NASH). The latter is often associated with other health issues or medical conditions such as obesity and diabetes, etc.
Effective diagnosis through liver biopsy is recommended my different health organizations across the globe, given that it will help define the level of risk at which a patient may be developing cirrhosis. Histological diagnosis of alcoholic steatohepatitis, however, should not be confused with the term “alcoholic hepatitis.” These are two different conditions, both derived from alcohol abuse. The latter is, by and large, a life threatening condition, since it can cause liver failure and this disease has rather high short term mortality rates and should be treated immediately. In most cases, liver transplant might be the only course of action.
It is worth noting that it is still unknown exactly what factor or factors triggers the development of alcoholic hepatitis. Pathogenesis and individual predisposition are of course influential but not determinant factors. As with other types of alcoholic liver diseases, gene-environment interactions can also be determinant.