What is the spectrum of alcoholic liver disease?

Alcohol causes a spectrum of progressive liver injury: alcoholic fatty liver (steatosis), then alcoholic hepatitis, and finally alcoholic cirrhosis. Steatosis is reversible with abstinence, but established cirrhosis is not.

Clinical relevance. Recognising the reversible-to-irreversible spectrum frames abstinence as the key to halting progression.

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Spectrum of alcoholic liver disease

Alcoholic liver disease (ALD) is a leading cause of liver disease worldwide and progresses through three overlapping stages.

The three stages

• Alcoholic fatty liver (steatosis): fat accumulation, develops in most heavy drinkers; reversible with abstinence.
• Alcoholic hepatitis: inflammation and hepatocyte necrosis superimposed on fatty change; potentially reversible but can be life-threatening.
• Alcoholic cirrhosis: irreversible fibrosis, the end stage; develops in only about 10-20% of heavy drinkers.

Burden

• Alcohol is a leading cause of liver disease, accounting for millions of deaths annually worldwide.

Key point

• The stages overlap and can coexist; progression depends on continued drinking and host factors.