| Abstract | | In many respects alcoholic liver disease still remains a riddle to the clinician, despite numerous studies and rich experience. The mechanism of alcoholic liver damage is not yet fully known, although we do know that acetaldehyde, a decomposition product of alcohol, and the microsomal ethanol oxydation system are mainly responsible. The diagnosis is based on precise history, clinical examination, laboratory and histologic findings. Questions turn up in connection with the clinically asymptomatic patient presenting a histologic picture of expressed liver damage. Treatment comprises giving up alcohol, introducing nutrition rich in proteins, vitamins and minerals, while the success of drug treatment is unclear. We know that corticosteroids prolong survival of patients with alcoholic hepatitis and liver encephalopathy, but the mechanism of the effect is not known. Much is expected from antifibrotic treatment of patients with liver cirrhosis, but these drugs are not applied routinely yet. In this era of organ transplantations, clinicians are pondering whether the patient with alcoholic liver cirrhosis is entitled to liver transplantation, medically and morally. The years to come will bring new knowledge about alcoholic liver disease and its more successful treatment. But the basic cause of the disease, namely alcohol consumption, must be kept in mind. Solving the problem must involve all of us: the physicians making the people aware of the danger, and society as a whole with an obligation to its own health.
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