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Alcohol and Alcoholism Advance Access originally published online on April 2, 2008
Alcohol and Alcoholism 2008 43(4):393-397; doi:10.1093/alcalc/agn013
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© The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved

Review

The Pervading Influence of Alcoholic Liver Disease in Hepatology

Roger Williams*

Institute of Hepatology, University College London Medical School, 69–75 Chenies Mews, London, WC1E 6HX, UK

* Correspondence should be addressed at: Institute of Hepatology, University College London Medical School, 69–75 Chenies Mews, London, WC1E 6HX, UK. Tel.: 00 44 207 679 6510/11; Fax: 00 44 207 380 0405; e-mail: roger.williams{at}ucl.ac.uk

Received 17 December 2007; accepted 29 January 2008


  Abstract

Rising levels of alcohol consumption in the UK are leading to substantial increases in morbidity and mortality from liver disease. Drinking is starting at an earlier age with binging an increasing common pattern, and women are overtaking men in the consumption. Manifestations of liver damage range from fatty liver to end-stage cirrhosis, but it is the increasing number of cases presenting with an acute alcoholic hepatitis (AAH) that are the cause for greatest concern. Development of well-validated prognostic scoring systems (Maddrey Modified Discriminant Function, Glasgow Alcohol Score) makes it possible to select those patients with AAH who are most likely to respond to corticosteroids. The results of early pilot studies of a number of anti-TNF agents are encouraging and with infliximab, reduction in portal pressure has been demonstrated to be consequent on controlling inflammatory processes in the liver. For those deteriorating to the stage of liver failure, artificial liver support with MARS is of value in correcting major pathophysiological disturbances and as a bridge to liver transplantation, the results of which both for end-stage alcoholic cirrhosis and for AAH—of which there is limited experience, are excellent. Even as the stringent regulatory measures needed to control rising alcohol consumption are introduced by government, the burden of liver disease in the UK will remain high for years to come.

Text of the Max Glatt Memorial Lecture 2007 given to The Medical Council on Alcohol


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