Pathogenesis of Alcoholic Liver Disease

Clin Liver Dis. 2016 Aug;20(3):445-56. doi: 10.1016/j.cld.2016.02.004. Epub 2016 Mar 28.


Alcoholic liver disease includes a broad clinical-histological spectrum from simple steatosis, cirrhosis, acute alcoholic hepatitis with or without cirrhosis to hepatocellular carcinoma as a complication of cirrhosis. The pathogenesis of alcoholic liver disease can be conceptually divided into (1) ethanol-mediated liver injury, (2) inflammatory immune response to injury, (3) intestinal permeability and microbiome changes. Corticosteroids may improve outcomes, but this is controversial and probably only impacts short-term survival. New pathophysiology-based therapies are under study, including antibiotics, caspase inhibition, interleukin-22, anakinra, FXR agonist and others. These studies provide hope for better future outcomes for this difficult disease.

Keywords: Alcoholic hepatitis; Alcoholic liver disease; Corticosteroids; Intestinal permeability; Microbiome; Sterile necrosis.

Publication types

  • Review

MeSH terms

  • Autophagy
  • Carcinoma, Hepatocellular / etiology
  • Epigenesis, Genetic
  • Gastrointestinal Microbiome
  • Humans
  • Inflammation / immunology
  • Lipid Metabolism
  • Liver Diseases, Alcoholic / etiology*
  • Liver Diseases, Alcoholic / physiopathology
  • Liver Diseases, Alcoholic / therapy
  • Liver Neoplasms / etiology
  • Risk Factors