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Clinical Aspects of Alcoholic Liver Disease

  • Mads Israelsen
  • Aleksander Krag
  • Maja Thiele
Chapter

Abstract

Alcohol is the number one cause of liver-related mortality worldwide. Patients with alcoholic liver disease die in excess from liver-related complications, compared to patients with liver disease of other etiologies. As a consequence, mortality and morbidity from alcoholic liver disease represent a huge financial and healthcare burden on society. To date, we have no tools to detect those patients with a harmful use of alcohol who will progress to liver-related complications. Accumulation of liver fibrosis is a key feature in progressive alcoholic liver disease and no pharmaceutical interventions have been developed for treatment of alcohol induced liver fibrosis. However, patients who drink in excess exhibit large individual differences in risk of progressing from simple fatty liver to fibrosis and cirrhosis. Those with cirrhosis are at risk of developing ascites, hepatic encephalopathy, bleeding varices and other complications to portal hypertension. Unfortunately, the disease progress is asymptomatic during 10–20 years. During this compensated phase, no routine biomarkers can sufficiently detect fibrosis. As a consequence, 75% of patients are diagnosed at a decompensated stage, when 5-year survival may be down to 12%. To improve the prognosis of alcoholic liver disease the following unmet needs must be solved: Better knowledge of the natural history and pathophysiology, more accurate non-invasive markers, effective treatment options and faster implementation of the newest knowledge. The gut-liver axis may play a main role in the pathophysiology. Multiple components in the gut-liver axis are suggested to drive disease progression including gut dysbiosis, impaired gut barrier function, activation of the innate immune system, hepatic cell damage and altered bile acid circulation. Many uncertainties still remain of how the different components of the gut-liver axis impact alcoholic liver disease in humans. In 2017 more than 20 clinical trials on ALD are testing gut modulating interventions including antibiotics, pro-, pre and synbiotics, faecal microbiota transplantation, adsorbants and bile acid modulating drugs.

Keywords

Alcoholic liver disease Steatohepatitis Liver fibrosis Burden of disease Natural history Cirrhosis Gut-liver axis Targeted treatment 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mads Israelsen
    • 1
    • 2
  • Aleksander Krag
    • 1
    • 2
  • Maja Thiele
    • 1
    • 2
  1. 1.Department of Gastroenterology and HepatologyOdense University HospitalOdenseDenmark
  2. 2.Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark

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