Alcohol‐Associated Liver Disease: Epidemiology, Pathogenesis, and Emerging Therapeutic Targets

Alcohol-associated liver disease (ALD) represents a leading cause of preventable liver-related morbidity and mortality worldwide. Despite its growing global burden, no pharmacological therapies targeting disease progression have achieved clinical approval, with management still centered on alcohol abstinence and supportive care. Classic pathogenic mechanisms, including ethanol metabolism, oxidative stress, innate immune activation, and regulated cell death, are well recognized, yet emerging evidence highlights the gut-liver axis and intestinal dysbiosis as critical, interactive drivers of disease pathophysiology. However, how gut microbial imbalance mechanistically intersects with these canonical pathways to accelerate ALD progression remains insufficiently integrated. This article summarizes the epidemiology, clinical manifestations, and pathogenesis of ALD. Importantly, we focus specifically on changes in the gut microbiota (including bacteria, fungi, and viruses) and microbial metabolites. We further discuss the interactive relationships between dysbiosis and these core mechanisms. Finally, we summarize progress in preclinical and clinical research on targeted strategies such as probiotics, fecal microbiota transplantation, and phage therapy. By synthesizing the research findings, we propose a stage-based, mechanism-oriented framework aimed at advancing the development of safer and more precise therapeutic interventions for ALD.