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Semin Liver Dis 2004; 24(3): 233-247
DOI: 10.1055/s-2004-832937
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Therapy of Alcoholic Liver Disease

Josh Levitsky1 , Mark E. Mailliard1 , 2 , 3
  • 1University of Nebraska College of Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
  • 2Associate Professor of Medicine, Veterans Affairs Medical Center, Omaha, Nebraska
  • 3Veterans Affairs Medical Center, Omaha, Nebraska
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Publication History

Publication Date:
03 September 2004 (online)

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Alcoholic liver disease (ALD) presents considerable challenges to clinicians. Screening for alcohol abuse and alcoholism should be routine and repeated annually with close attention to signs and symptoms of liver disease. In patients with evidence of liver dysfunction or injury, consideration should be given to performance of liver biopsy for diagnosis and prognosis and prior to initiation of medication with the potential for significant side effects. Therapy depends on the spectrum of pathological liver injury: alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. Abstention is the foundation of therapy for an alcohol problem. Alcoholic fatty liver should improve with abstention, but the similarity to the pathogenesis of nonalcoholic fatty liver and potential for progressive injury merits consideration of lipotropic agents. The continuing mortality, poor acceptance of corticosteroids, and identification of tumor necrosis factor-alpha (TNF-α) as an integral component has led to studies of pentoxifylline and, recently, anti-TNF antibody to neutralize cytokines in the therapy of severe alcoholic hepatitis. Antioxidant therapy of alcoholic cirrhosis has significant promise but will require large clinical trials.

KEYWORDS

Liver disease - alcoholic - corticosteroids - tumor necrosis factor-alpha - antibodies - monoclonal

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Mark MailliardM.D. 

University of Nebraska College of Medicine, Division of Gastroenterology and Hepatology

Box 982000 Nebraska Medical Center

Omaha, NE 68198

Email: mmaillia@unmc.edu

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