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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2016; 22(1): 8-23
Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.8
Optimal management for alcoholic liver disease: Conventional medications, natural therapy or combination?
Moon-Sun Kim, Madeleine Ong, Xianqin Qu
Moon-Sun Kim, Madeleine Ong, XianQin Qu, School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW 2007, Australia
Moon-Sun Kim, Faculty of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia
Author contributions: Kim MS, Ong M and Qu X contributed to writing the manuscript; Kim MS produced the figures and Ong M thoroughly edited the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xianqin Qu, PhD, MD, School of Medical and Molecular Biosciences, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW 2007, Australia. xianqin.qu@uts.edu.au
Telephone: +61-2-95147852 Fax: +61-2-95147852
Received: April 28, 2015
Peer-review started: May 5, 2015
First decision: June 23, 2015
Revised: July 7, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 7, 2016
Processing time: 246 Days and 18.8 Hours
Abstract

Alcohol consumption is the principal factor in the pathogenesis of chronic liver diseases. Alcoholic liver disease (ALD) is defined by histological lesions on the liver that can range from simple hepatic steatosis to more advanced stages such as alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and liver failure. As one of the oldest forms of liver injury known to humans, ALD is still a leading cause of liver-related morbidity and mortality and the burden is exerting on medical systems with hospitalization and management costs rising constantly worldwide. Although the biological mechanisms, including increasing of acetaldehyde, oxidative stress with induction of cytochrome p450 2E1, inflammatory cytokine release, abnormal lipid metabolism and induction of hepatocyte apoptosis, by which chronic alcohol consumption triggers serious complex progression of ALD is well established, there is no universally accepted therapy to prevent or reverse. In this article, we have briefly reviewed the pathogenesis of ALD and the molecular targets for development of novel therapies. This review is focused on current therapeutic strategies for ALD, including lifestyle modification with nutrition supplements, available pharmacological drugs and new agents that are under development, liver transplantation, application of complementary medicines, and their combination. The relevant molecular mechanisms of each conventional medication and natural agent have been reviewed according to current available knowledge in the literature. We also summarized efficacy vs safety on conventional and herbal medicines which are specifically used for the prevention and treatment of ALD. Through a system review, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for ALD and its complications. It is worthwhile to conduct large-scale, multiple centre clinical trials to further prove the safety and benefits for the integrative therapy on ALD.

Keywords: Alcoholic liver disease; Alcohol hepatitis; Conventional medicines; Natural medicines; Hepatic lipid metabolism; Hepatic inflammation; Combination therapy

Core tip: The aim of this article is to review the impairment of hepatocellular dysfunction in alcoholic liver diseases and their prospective managements. Specifically, we focused on the natural therapies with their efficacies and safeties. Moreover, we summarized molecular mechanisms of herbal therapy to treat alcoholic liver disease (ALD). With evidence-based natural therapy, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for this complex liver disease. It is worthwhile to conduct large-scale, multiple centre clinical trials further to prove the safety and benefits for the integrative therapy on ALD.