Immunologic aspects of liver disease

Immunology of alcoholic liver disease

Alcohol-induced liver injury is a reflection of the immunologic response of the liver to this stimulus. Reported studies of immunologic abnormalities in alcoholic liver disease (ALD) patients suggest that immunologic response plays a key role in the pathogenesis of chronic liver disease in alcoholics, and have contributed to the understanding of how some patients with ALD progress into alcoholic liver cirrhosis. The immunologic response of the liver is reflected in alcoholic fatty liver disease, hyaline necrosis, and cirrhosis, promoted by the role of neutrophils in damaging liver cells through cytotoxicity, and lymphocytes through cytotoxicity, inducing fibrogenesis of the liver and formation of immune complexes responsible for immune complex-mediated cytotoxicity, in addition to the role of different chemokines in attracting leucocytes, inducing fibrogenesis and liver cell apoptosis, with the established mechanism by which Mallory bodies evoke both cellular and humoral immunity contributing to the process of alcoholic liver cirrhosis, which plays a key role in transformation of alcoholic hepatitis to cirrhosis. At present, research is underway to find modalities to correct the induced immunologic changes, so at this time, it is necessary to avoid alcoholism, with the use of social and educational programs to stop alcoholism.

Hepatic fibrosis and cirrhosis in tropical countries (including portal hypertension)

The spectrum of diseases seen in patients from certain 'tropical areas' requires that a physician be aware of some of the syndromes discussed here. A high index of suspicion for less usual causes of cirrhosis is imperative when evaluating such patients presenting with hepatocellular disease. The differential must be expanded and the work-up complete. Liver biopsy should be performed as early in the course of disease as is feasible and will often provide valuable diagnostic information. It will not only facilitate treatment but allow for needed clinical trials and may help to increase our understanding of the various disease processes.

Use of colchicine and steroids in the treatment of alcoholic liver disease

To date, only one group has reported its clinical experience with colchicine therapy. This study included a randomized clinical trial of 22 patients and an open study of 53 patients. The beneficial effect of 1 mg colchicine daily for five days a week has been promising but not convincing. Corticosteroid therapy for the treatment of alcoholic hepatitis was evaluated in nine short-term randomized clinical trials that included 150 treated and 161 control patients with a mortality rate of 37 and 44%, respectively. In these studies, encephalopathy was present in 80 treated and 76 control patients with a mortality rate of 59 and 74%, respectively. None of these differences is significant. The studies did document that patients with mild disease require no specific therapy besides abstinence and general supportive measures; those with severe disease showed a trend toward better survival on corticosteroid therapy. This trend was strong in the earlier publications, but was absent in the most recent studies, which included the largest numbers of patients.