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Nonetheless, once steatohepatitis has developed, the risk of development of cirrhosis is increased compared with simple steatosis. However, less than half of individuals with alcoholic steatosis, who continue to drink alcohol, will progress to fibrosis and only 10%-20% will eventually progress to cirrhosis. While alcohol is a well established hepatotoxin with higher levels of consumption associated with increased risk of development of ALD, no absolute threshold of alcohol consumption is necessary for the development of liver injury, and no direct linear correlation between level of alcohol consumption and severity of ALD has been established.Īpproximately 60%-90% of individuals who drink more than 60 g of alcohol per day have been shown to have hepatic steatosis. In the United States, 31522 adults died from liver cirrhosis in 2009, with 48.2% of these deaths attributable to alcohol. In 2010, ALD resulted in 493300 deaths worldwide and 14.5 million disability adjusted life years with alcoholic cirrhosis comprising 47.9% of all liver cirrhosis deaths. Rates of ALD are highest in countries with the highest rates of alcohol consumption including Eastern Europe, Southern Europe and the United Kingdom. In the United States, the estimated annual per capita consumption of alcohol is 8.4 L per person. Levels of alcohol consumption vary geographically with Eastern European countries having the highest annual per capita consumption (15.7 L per person), while North Africa and the Middle East have the lowest annual per capita consumption (1.0 L per person). There is a strong correlation between the prevalence of ALD, specifically cirrhosis, and a country’s annual per capita alcohol consumption. In the United States, almost 9% of adults meet criteria for an alcohol-use disorder with alcohol use disorders ranking in the top 20 leading diseases contributing to disability adjusted life years and resulting in approximately $223.5 billion of societal costs annually. Excessive or harmful alcohol use is ranked as one of the top five risk factors for death and disability globally and results in 2.5 million deaths and 69.4 million annual disability adjusted life years. Alcoholic liver disease (ALD) is a general term used to refer to this spectrum of alcohol-related liver injuries.Įxcessive alcohol consumption is a risk factor for a multitude of adverse health consequences and is indeed one of the leading causes of preventable morbidity and mortality worldwide with a significant burden attributable to ALD. Because of the potential reversible nature of ALD with sobriety, regular screening of the general population and early diagnosis are essential.Īlcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. The histological features of ALD can ultimately define the diagnosis according to the typical presence and distribution of hepatic steatosis, inflammation, and Mallory-Denk bodies. In unclear cases, the diagnosis can be supported by imaging and liver biopsy. Typical laboratory findings in ALD include transaminase levels with aspartate aminotransferase greater than alanine aminotransferase as well as increased mean corpuscular volume, gamma-glutamyltranspeptidase, and IgA to IgG ratio. In addition, clinical findings may be absent or minimal in early ALD characterized by hepatic steatosis. However, the diagnosis of ALD can be clinically challenging as there is no single diagnostic test that confirms the diagnosis and patients may not be forthcoming about their degree of alcohol consumption. The diagnosis of ALD can generally be made based on history, clinical and laboratory findings. All patients who present with clinical features of hepatitis or chronic liver disease or who have elevated serum elevated transaminase levels should be screened for an alcohol use disorder. Alcoholic liver disease (ALD) is a general term used to refer to this spectrum of alcohol-related liver injuries. Alcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis.