PATHOGENESIS, DIAGNOSIS, AND MANAGEMENT OF ALCOHOLIC LIVER DISEASE: A COMPREHENSIVE REVIEW

Abstract

Alcoholic liver disease (ALD) remains a leading cause of morbidity and mortality worldwide, with excessive alcohol consumption contributing to 3.3 million deaths annually. ALD encompasses a spectrum of liver disorders, ranging from reversible alcoholic fatty liver (steatosis) to alcoholic hepatitis and cirrhosis. The progression of ALD is influenced by factors such as the quantity and duration of alcohol intake, viral hepatitis infections (HBV, HCV), and metabolic comorbidities. Pathophysiologically, ethanol metabolism primarily occurs via alcohol dehydrogenase, cytochrome P450 2E1, and catalase systems, producing acetaldehyde and reactive oxygen/nitrogen species that induce hepatocellular damage, steatosis, inflammation, and fibrosis.

Clinical manifestations vary with disease stage, from asymptomatic fatty liver to jaundice, portal hypertension, and liver failure in cirrhosis. Diagnostic evaluation includes a combination of clinical history, screening questionnaires (CAGE, AUDIT), liver function tests, fibrosis assessment (FibroTest, elastography), imaging, and, when indicated, liver biopsy. Effective management relies on sustained alcohol abstinence, nutritional support, pharmacotherapy (e.g., ademetionine for hepatoprotection, baclofen for alcohol use disorder), and behavioral interventions. Early detection and comprehensive care are essential to reduce disease progression and improve outcomes in patients with ALD.