Gastroenterology Special Isssue on Alcoholic vs Non-Alcoholic Fatty Liver Disease
In an introduction to the issue, Arun Sanyal et al write that alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) have much in common, including histologic features and activation of pathways involved in their pathogenesis. They also have some distinct histologic features, causes, and factors linked to mortality. The goal of this special issue is to review what we know about fatty liver disease and identify common pathways and mechanisms, which could provide important information about pathogenesis or treatment strategies.
For example, Quentin M. Anstee et al discuss the functions of proteins encoded by risk variants in genes such as PNPLA3 and TM6SF2, as well as epigenetic factors that contribute to the pathogenesis of ALD and NAFLD.
Naga S. Betrapally et al review differences in the stages of alcohol-associated disease in patients who continue to drink compared with those who stop, with respect to the composition and function of the intestinal microbiota and intestinal integrity. They also comment on the potential of microbial therapy for patients with NAFLD or ALD.
A higher proportion of patients with NAFLD die from cardiovascular disorders than patients with ALD, whereas a higher proportion of patients with ALD die from liver disease, report Zobair Younossi and Linda Henry. They discuss the morbidity, impairment to health-related quality of life, and economic costs to society of these diseases.
Suthat Liangpunsakul et al explain individual differences in susceptibility to the toxic effects of alcohol, such as pattern of alcohol consumption, sex, environmental factors (such as diet), and genetic factors, which vary widely in different parts of the world. Alcoholic liver disease is becoming more common in many parts of Asia, but is decreasing in Western Europe, so treatment approaches, including availability of medications, models of care, and approach to transplantation, must also differ among regions.