AIMS: To examine the correlation between the severity of alcohol induced liver damage and the presence of intracytoplasmic red bodies (defined as periodic acid-Schiff diastase negative, globular, hyaline cytoplasmic inclusions larger in size than the hepatocyte nucleolus). To investigate the incidence of intracytoplasmic red bodies (ICRBs) in non-alcoholic liver disease. METHODS: Liver biopsy specimens from 53 patients with alcoholic liver disease and 50 patients with a variety of nonalcohol related liver diseases were examined by light microscopy for the presence of ICRBs. For the 53 patients with alcoholic liver disease an assessment of recent alcohol consumption was made indirectly from measurements of red cell volume (MCV) and plasma gamma-glutamyl transferase (GGT). In addition, 10 liver biopsies with alcohol induced changes and ICRBs were examined by electron microscopy for the presence of mitochondrial aberrations including enlargement. RESULTS: ICRBs were detected in 18 of the 53 liver biopsy specimens showing alcohol induced changes, and were more abundant in those showing more advanced changes. Those patients whose liver specimens contained ICRBs were found to have a significantly higher mean plasma GGT activity and mean MCV than those individuals whose liver biopsy specimens did not contain ICRBs. Two of the 50 liver biopsy specimens showing non-alcohol induced changes contained ICRBs. Giant mitochondria were not detected by electron microscopy, but this may reflect sampling. CONCLUSIONS: The results of this study indicate that ICRBs are definitely associated with alcoholic liver disease and are more likely to be found in liver biopsy specimens showing more advanced alcohol induced damage, and when recent alcohol consumption has been high.