Anouti Ahmad, Kerr Thomas A, Mitchell Mack C, Cotter Thomas G
Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA.
Gastroenterol Rep (Oxf). 2024 Nov 5;12:goae097. doi: 10.1093/gastro/goae097. eCollection 2024.
Alcohol-associated liver disease (ALD) is a significant global health challenge, encompassing a spectrum from steatotic liver disease to cirrhosis and alcohol-associated hepatitis, and contributed to 25% of global cirrhosis deaths in 2019. The identification of both modifiable (e.g. heavy drinking, metabolic syndromes) and non-modifiable risk factors (e.g. genetic predispositions) is crucial for effective disease management. Alcohol use assessment and treatment, by using both behavioral therapy and pharmacotherapeutic modalities, nutrition support, and optimization of liver disease modifiers, form the cornerstone of management. Advances in medical therapies, such as fecal microbiota transplantation and novel agents such as IL-22, are being explored for their therapeutic potential. A unifying theme in ALD care is the need for a personalized approach to management, accounting for the spectrum of the disease and individual patient characteristics, to tailor interventions effectively. Finally, it is essential to address the challenges to effective ALD treatment, including socioeconomic, logistical, and stigma-related barriers, to improve patient outcomes. This review discusses the current knowledge on ALD, including epidemiology, pathophysiology, risk factors, and management strategies, highlighting the critical role of integrated care models.
酒精性肝病（ALD）是一项重大的全球健康挑战，涵盖从脂肪性肝病到肝硬化以及酒精性肝炎的一系列疾病，在2019年占全球肝硬化死亡人数的25%。识别可改变的（如大量饮酒、代谢综合征）和不可改变的风险因素（如遗传易感性）对于有效的疾病管理至关重要。通过行为疗法和药物治疗方式、营养支持以及优化肝病调节因素进行酒精使用评估和治疗，构成了管理的基石。正在探索粪便微生物群移植等医学疗法以及白细胞介素-22等新型药物的治疗潜力。ALD护理的一个统一主题是需要采用个性化的管理方法，考虑到疾病的范围和个体患者特征，以有效调整干预措施。最后，应对有效治疗ALD的挑战，包括社会经济、后勤和与耻辱感相关的障碍，对于改善患者预后至关重要。本综述讨论了关于ALD的当前知识，包括流行病学、病理生理学、风险因素和管理策略，强调了综合护理模式的关键作用。
