title: Pharmacotherapy of alcoholic liver disease in clinical practice.
abstract: OBJECTIVE
  Alcohol is the most commonly used addictive substance and alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide, responsible for 47.9% of all liver chronic deaths. Despite ALD has a significant burden on the health, few therapeutic advances have been made in the last 40 years, particularly in the long-term management of these patients.
  
  
  METHODS
  we searched in PubMed, Scopus, Google Scholar, and MEDLINE databases to identify relevant English language publications focused on long-term therapy of ALD.
  
  
  RESULTS
  From the huge literature on this topic, including about 755 studies, 75 were selected as eligible including clinical trials and meta-analysis.
  
  
  CONCLUSIONS
  Abstinence remains the cornerstone of ALD therapy but it is also the most difficult therapeutic target to achieve and the risk of recidivism is very high at any time. Several drugs (disulfiram, naltrexone, acamprosate, sodium oxybate) have proven to be effective to prevent alcohol relapse and increase the abstinence, although the psychotherapeutic support remains crucial. Baclofen seems to be effective to improve abstinence, showing an excellent safety and tolerability. ALD is often complicated by a state of malnutrition, which is related to a worst mortality. A nutritional therapy may improve survival in cirrhotic patients, reversing muscle wasting, weight loss and specific nutritional deficiencies. While in aggressive forms of alcoholic hepatitis are recommended specific drug treatments, including glucocorticoids or pentoxifylline, for the long-term treatment of ALD, specific treatments aimed at stopping the progression of fibrosis are not yet approved, but there are some future perspective in this field, including probiotics and antibiotics, caspase inhibitors, osteopontin and endocannabinoids.
authors.affiliation: Internal Medicine and Hepatology Department, Second University of Naples, Naples, Italy.
authors.forename: V
authors.identifier: http://orcid.org/0000-0002-3584-2414
authors.initials: V
authors.lastname: Rosato
authors.affiliation: Department of Health Science, University Magna Graecia, Catanzaro, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Abenavoli
authors.affiliation: Gastroenterology and Endoscopy Unit, Second University of Naples, Naples, Italy.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-0885-0793
authors.initials: A
authors.lastname: Federico
authors.affiliation: Internal Medicine and Hepatology Unit, University of Salerno, Baronissi, Italy.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-0550-8201
authors.initials: M
authors.lastname: Masarone
authors.affiliation: Internal Medicine and Hepatology Unit, University of Salerno, Baronissi, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Persico
mesh_terms: D000427:Alcohol Deterrents / Q000627:therapeutic use; D004035:Diet Therapy / Q000379:methods; D016166:Free Radical Scavengers / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control; D008108:Liver Diseases, Alcoholic / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D011613:Psychotherapy / Q000379:methods; D012307:Risk Factors
chemical_list: D000427:Alcohol Deterrents; D016166:Free Radical Scavengers; D005938:Glucocorticoids; D009292:Narcotic Antagonists