For many years, alcoholic liver disease has been known to be one of the major medical consequences of chronic alcohol use. Although the toxic effects of alcohol on hepatic cells can be demonstrated with acute ingestion, alcoholic liver disease is usually associated with heavy alcohol intake for a prolonged period of time. Its prevalence in any adult population is highly correlated with per capita consumption of alcohol, even though only a small but variable proportion of the drinking population consume enough to constitute increased risk of organ damage.

Only recently has epidemiologic research emphasis been placed on differentiating the various histologic expressions of alcoholic liver injury. The most important alcohol-induced liver lesions are fatty liver, alcoholic hepatitis, and cirrhosis. The first two clinicopathologic states are usually reversible on abstinence from alcohol, whereas cirrhosis is irreversible, usually resulting in liver failure and death. Some descriptions of the natural history of alcoholic liver disease suggest that fatty liver and alcoholic hepatitis may precede the development of cirrhosis. Although the pathogenic mechanisms involved in the progression to an established cirrhosis are not clear, consensus of available evidence supports the precirrhotic nature of alcoholic he pa ti ti^.^ Clinically, it appears that fatty liver is a relatively benign and nonprogressive lesion also seen in a multitude of other conditions, including obesity, diabetes mellitus, congestive heart failure, alimentary disorders, and kwa~ hiorkor.~ Although a close positive correlation between total cumulative dose of alcohol consumed and the incidence of liver damage has convincingly been demonstrated, not all heavy drinkers develop serious alcoholic liver disease. Approximately 10% of the biopsies from living alcoholics who manifest clinical or laboratory evidence of hepatic dysfunction will show cirrho~ is.~ It has been estimated that 10 to 35% of heavy drinkers develop alcoholic hepatitis, whereas evidence of some features of