Alcohol-related liver disease (ARLD) is a major health concern in Western countries, where alcohol consumption remains high. The Merck Manuals’ new video, Physician Facts: Alcohol-Related Liver Disease, provides essential insights into the progression of liver disorders linked to chronic alcohol use. These conditions often develop in sequence but can also coexist, including alcohol-associated hepatic steatosis (fatty liver), alcoholic hepatitis, and alcohol-associated cirrhosis. In severe cases, liver damage can lead to hepatocellular carcinoma, especially when other risk factors like iron accumulation are present.

The primary risk factors for ARLD include the quantity and duration of alcohol consumption, genetic predispositions, metabolic traits, and obesity. While moderate drinking is defined as one drink per day for women and two for men, the World Health Organization states that no level of alcohol consumption is entirely safe for health. Heavy drinking, binge drinking, and coexisting liver conditions significantly increase the likelihood of liver damage. Patients diagnosed with ARLD or at high risk are advised to abstain from alcohol entirely.

Alcohol metabolism plays a crucial role in liver damage. Ethanol is primarily processed in the liver by enzymes such as alcohol dehydrogenase (ADH) and cytochrome P-450 2E1 (CYP2E1). Chronic alcohol consumption leads to oxidative stress, inflammation, and fat accumulation in liver cells. Additionally, alcohol alters gut permeability, allowing harmful endotoxins to enter the liver, triggering an inflammatory response that worsens tissue damage. Over time, this cycle of inflammation, cell death, and fibrosis leads to cirrhosis and its complications, including portal hypertension and liver failure.

The Merck Manuals provide comprehensive, freely accessible medical information on ARLD and other health conditions. Their content, reviewed by medical experts, includes videos, animations, and interactive resources to support public and professional education. As alcohol-related liver disease continues to rise, increasing awareness of its risks and preventive measures is crucial. Early screening, lifestyle modifications, and medical interventions can help mitigate the devastating impact of chronic alcohol use on liver health.

Find more from Merck Manuals (USA, January 2025)