LIVER-DAMAGE - MECHANISMS AND MANAGEMENT

Despite recent advances in our knowledge of the mechanisms of alcohol- induced liver damage, abstinence from alcohol and supportive measures remain the mainstays of management for the majority of patients. Progr ess has been made in our understanding of ethanol metabolism, the role of acetaldehyde, and both genetic and environmental factors responsib le for the variation in individual susceptibility to alcoholic liver d isease. Evidence for the involvement of the immune system and the effe cts of alcohol on hepatic fibrosis are also reviewed. Recent therapeut ic trials of corticosteroids in acute alcoholic hepatitis have confirm ed their benefit in patients who have a high risk of mortality. For pa tients with end-stage cirrhosis, orthotopic liver transplantation is n ow an accepted therapy in selected patients who have a good prognosis for future abstinence.