Extrahepatic Manifestations in Alcoholic Liver Disease

Abstract

Though liver is the most commonly affected organ in patients with chronic and excessive intake of alcohol, no organ is immune to toxic effects of alcohol and patients with alcohol-related liver disease (ALD) can suffer from a wide list of extrahepatic manifestations involving gastrointestinal tract, central and peripheral nervous systems, cardio vascular system, musculo-skeletal system, disruption of nutritional status, endocrinological abnormalities, hematological abnormalities and immune dysfunction. These extrahepatic organ involvements are usually overlooked by hepatologists and physicians who are mostly focused on managing life threatening complications of ALD. As a result, there is delayed diagnosis, delay in the initiation of appropriate treatment and late referral to other specialists. Some of these manifestations are of utmost clinical importance (e.g. delirium tremans and Wernicke's encephalopathy) because an early diagnosis and treatment can lead to full recovery while delayed or no treatment can result in death. On the other hand, several extrahepatic manifestations are of prognostic significance (such as alcoholic cardiomyopathy and malignancies) in which there is an increased risk of morbidity and mortality. Hence, a clear understanding and awareness of the extrahepatic manifestations of ALD is quintessential for proper management of these patients.

Keywords: ACE, Angiotensin-Converting-Enzyme; ALD, Alcohol related Liver Disease; AUD, Alcohol Use Disorder; GAVE, Gastric Antral Vascular Ectasia; GERD, Gastro-Esophageal Reflux Disease; HCC, Hepatocellular Carcinoma; HIV, Human Immunodeficiency Virus; IARC, International Agency for Research on Cancer; IL, Interleukin; NERD, Non-Erosive Reflux Disease; PPI, Proton Pump Inhibitors; TNF, Tumour Necrosis Factor; UGI, Upper Gastrointestinal; WHO, World Health Organization; alcohol use disorder; alcohol withdrawal syndrome; alcoholic cardiomyopathy; alcoholic liver disease; alcoholic myopathy.

Figure 1

List of extrahepatic manifestations of Alcohol associated liver disease (ALD).

Figure 2

Pathophysiology of extrahepatic manifestations of Alcohol associated liver disease (ALD).