《2010AASLD酒精性肝病》内容预览

Alcoholic liver disease (ALD) encompasses a spectrum of injury, ranging from simple steatosis to frank cirrhosis. It may well represent the oldest form of liver injury known to humankind. Evidence suggests that fermented bever-ages existed at least as early as the Neolithic period (circa 10,000 B.C.),and liver disease related to it almost as long. Alcohol remains a major cause of liver disease world-wide. It is common for patients with ALD to share risk factors for simultaneous injury from other liver insults (e.g., coexisting nonalcoholic fatty liver disease, or chronic viral hepatitis). Many of the natural history stud-ies of ALD, and even treatment trials, were performed before these other liver diseases were recognized, or spe-cific testing was possible. Thus, the individual effect of alcohol in some of these studies may have been con-founded by the presence of these additional injuries. De-spite this limitation, the data regarding ALD are robust enough to draw conclusions about the pathophysiology of this disease. Possible factors that affect the development of liver injury include the dose, duration, and type of alcohol consumption; drinking patterns; sex; ethnicity; and asso-ciated risk factors including obesity, iron overload, con-comitant infection with viral hepatitis, and genetic factors.

Geographic variability exists in the patterns of alcohol intake throughout the world.Approximately two-thirds of adult Americans drink some alcohol.The majority drink small or moderate amounts and do so without evi-dence of clinical disease.A subgroup of drinkers, how-ever, drink excessively, develop physical tolerance and withdrawal, and are diagnosed with alcohol depen-dence.A second subset, alcohol abusers and problem drinkers, are those who engage in harmful use of alcohol, defined by the development of negative social and health consequences of drinking (e.g., unemployment, loss of family, organ damage, accidental injury, or death).

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