Liver disease is the fifth commonest cause of death in the UK. Observational and case-controlled studies have suggested that coffee is beneficial in liver disease, but this evidence has yet to be evaluated or placed into the context of the natural history of liver disease. The aim of this study was to review the current evidence for the role of coffee in liver disease. Several studies consistently show that coffee drinkers have a reduced risk of abnormal liver function tests, cirrhosis and hepatocellular carcinoma. There is a clear dose response to this benefit. As the effect of this widely available food substance seems substantial further data, ideally from an interventional study of coffee in patients with liver disease, is urgently required particularly because of the potential to reduce fibrosis and hepatocellular carcinoma risk. This would be the first intervention of its kind to have proven benefit irrespective of etiology of liver disease. Eur J Gastroenterol Hepatol 22:1277-1283 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.