Alcoholic Liver Disease.

The traditional approach to alcoholism is treatment of underlying psychological and behavioral problems. Earlier and more direct avenues to prevent or counteract alcohol's effects include a focus on early detection of alcoholism, using, in part, biochemical markers of heavy drinking such as carbohydrate-deficient transferrin (CDT) and screening, among heavy users of alcohol, for signs of medical complications. Only a few heavy drinkers eventually develop liver cirrhosis. Because no practical genetic markers exist indicating who will develop fibrosis and cirrhosis, heavy drinkers who have signs of liver injury should undergo liver biopsy to determine whether they have perivenular fibrosis, a recognized precursor lesion to cirrhosis. Those who do should start intense treatment efforts, such as correction of nutritional deficits, curbing alcohol consumption, and participation in ongoing controlled trials. Some "supernutrients" have been effective in baboons, including S-adenosylmethionine for the treatment of alcohol-induced liver injury and polyenylphosphatidylcholine for the prevention of fibrosis. Both drugs are now being tested in humans. Prednisolone improves survival in patients with alcoholic hepatitis who have either spontaneous hepatic encephalopathy or a high "discriminant function."