Alcohol-Associated Liver Disease and Alcoholic Hepatitis: Pathophysiology and therapeutic strategies
Keywords:
Alcohol-associated liver disease (ALD), alcoholic hepatitis, gut-liver axis, oxidative stress, cytokeratin-18, corticosteroids,, liver transplantation, mesenchymal stem cells, clinical biomarkers, public health burden (India)Abstract
Alcohol-associated liver disease (ALD) remains a primary driver of global hepatology-related mortality, presenting a progressive pathological continuum that terminates in cirrhosis and hepatocellular carcinoma. Within this spectrum, alcoholic hepatitis (AH) represents a critical, acute inflammatory crisis that carries an alarmingly high short-term mortality rate and demands immediate clinical intervention. This comprehensive review examines the multifaceted pathogenesis driving AH, focusing on the interplay between CYP2E1-mediated oxidative stress, toxic acetaldehyde accumulation, and gut dysbiosis-induced macrophage activation. Given the rising burden of chronic liver disease in India—where shifting lifestyles and metabolic factors increasingly intersect with heavy alcohol use—we highlight the evolving epidemiological landscape and existing public health gaps. We evaluate current diagnostic paradigms, assessing the clinical utility of traditional markers alongside emerging non-invasive indicators like cytokeratin-18. Finally, we scrutinize modern therapeutic strategies; while absolute abstinence and nutritional rehabilitation form the bedrock of management, we deliberate on the limits of standard corticosteroid regimens and explore the clinical horizons of gut-microbiota modulation and mesenchymal stem cell therapies.
