INTRODUCTION

Alcohol is a socially accepted hepatotoxin and its abuse costs approximately $200 billion annually. In the U.S. population, 7–10% meets the diagnostic criteria for alcohol abuse or alcoholism. Alcohol accounts for 40–50% of all the deaths due to cirrhosis and remains the most common cause of liver-related mortality. However, alcoholic liver disease (ALD) represents a spectrum of histologic changes as shown in Table 6.1 with different clinical outcomes.

The mortality rate of alcoholic fatty liver is insignificant, while the age adjusted death rate for alcoholic cirrhosis is 3.8 per 100,000. The five- and 10-year survival rates for alcoholic cirrhosis without liver transplantation are 23% and 7%, respectively, which is significantly less than other forms of cirrhosis (see Table 6.2).

RISK FACTORS

However, it has been estimated that although 75–100% of heavy drinkers show evidence of fatty liver, only 8–20% of patients will develop cirrhosis. Therefore, other factors must play a role in placing these individuals at risk for developing more severe forms of ALD. A number of risk factors have been proposed as shown in Figure 6.1, but none of them can either singly or in combination completely explain the reason why only a minority of individuals ingesting large amounts of alcohol develop ALD.

Quantity of Alcohol Ingested

The quantity of alcohol ingested is the most important risk factor (Table 6.3). Although most investigators agree that those who drink heavily (4–5 drinks per day) are at risk for ALD, others.