How to Distinguish between Alcoholic and Non-Alcoholic Liver Disease?

Sa？etak Alcohol is still one of the most common etiologic factors of liver injury in nearly every part of the world. In many societies alcohol consumption is generally accepted and often an indispensable part of various social events, practically integrated into human culture, making alcohol one of the leading causes of mortality and morbidity in the world. Whether we are talking about daily consumption or periodic intake of a large amount of alcohol, its hepatotoxic effect is manifested by a series of clinical and histopathological features ranging from steatosis and alcoholic hepatitis to liver fibrosis and cirrhosis. Diagnosing alcoholic liver disease (ALD) remains a challenge, as there are no diagnostic parameters to confirm or exclude the disease, and the diagnosis is mainly based on anamnestic data on chronic alcohol consumption and the exclusion of other possible etiologic agents of liver injury. The combination of specific biomarkers may be an indication of ALD, but in order to distinguish whether it is a case of alcoholic or non-alcoholic liver disease, diagnostic workup must be aimed at excluding viral, autoimmune and metabolic diseases, as well as morphological changes in hepatic parenchyma. Over the last few years, we have been witnessing an increase in the incidence of non-alcoholic fatty liver disease (NAFLD), an entity considered hepatic manifestation of metabolic syndrome whose histopathological spectrum and clinical course resemble ALD. Since the fundamental difference between ALD and NAFLD is in the amount of alcohol consumed, correct diagnosis is sometimes more difficult to reach due to a growing number of overweight patients with other metabolic syndrome elements who consume large amounts of alcohol