The practical business of treatment--16. Can't treat, won't treat? Alcoholic liver disease.

An alcohol intake of more than 35 units per week will predispose to alcoholic liver disease, although not all patients with alcohol-induced liver damage have a dependency syndrome and only about 20% of those with an unremitting heavy alcohol intake will develop liver disease. In those with evidence of chronic liver disease, a liver biopsy is the most important investigation because it confirms the diagnosis and is indicative of the prognosis. Abstinence remains the mainstay of treatment and a multi-disciplinary approach is the best way to achieve this in most cases. In patients with severe alcoholic hepatitis, specific therapies such as high dose corticosteroids and propylthiouracil have shown promising results but are still under evaluation. Liver transplantation has been used successfully in patients with recurrent complications arising from portal hypertension, but whether a minimum period of abstinence should be a requirement remains the subject of debate.