Alcoholic Liver Disease

Alcohol abuse is a leading cause of morbidity and mortality throughout the world. It is estimated that in the United States as many as 10 % of men and 3 % of women may suffer from persistent problems related to the use of alcohol. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association divides alcohol use disorders into "alcohol dependence" and "alcohol abuse." Alcohol dependence is indicated by evidence of tolerance and/or symptoms of withdrawal such as delirium tremens (DTs) or alcohol withdrawal seizures (rum fits) upon cessation of drinking. Alcohol abuse is characterized by recurrent performance problems at school or on the job that result either from the after effects of drinking alcohol or from intoxication on the job or at school. In addition, patients with alcohol abuse disorders may use alcohol in physically adverse circumstances (e.g. while driving) and may miss work or school or neglect child care or household responsibilities because of alcohol use. Legal difficulties related to alcohol use are also common. Patients with alcohol abuse disorders often continue to consume alcohol despite the knowledge that continued consumption poses significant social or interpersonal problems for them. People with alcohol use disorders often consume alcohol despite knowing that they suffer from alcohol-related medical problems such as liver disease.

Alcohol affects many organ systems of the body, but perhaps most notably affected are the central nervous system and the liver. Almost all ingested alcohol is metabolized in the liver and excessive alcohol use can lead to acute and chronic liver disease. Liver cirrhosis resulting from alcohol abuse is one of the ten leading causes of death in the United States.

From data obtained in autopsy studies, it appears that between 10 % and 15 % of alcoholics have cirrhosis at the time of death. It is unknown why some alcoholics develop liver disease while others do not. One possibility is that there are genetic factors that predispose some alcoholics to liver disease. Some data also suggest that co-factors such as chronic infection with hepatitis C virus may increase the risk of the development of cirrhosis in an alcoholic. In general, women who drink an equal amount of alcohol are at higher risk than men for the development of liver disease, possibly because of decreased metabolism of alcohol in the stomach prior to absorption.By Howard J. Worman, M. D.( www.cumc.columbia.edu )