Overview
Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and a frequent indication for liver transplantation worldwide 1. It ranges from early asymptomatic injury to advanced disease with decompensation and portal hypertension, often progressing faster than other liver etiologies 1.Diagnosis
Alcohol-associated hepatitis (AH) is a unique phenotype of advanced ALD characterized by rapid onset or worsening jaundice and acute on chronic liver failure in severe forms 1.
The Model for End-Stage Liver Disease (MELD) score is the most accurate for stratifying AH severity, with a score >20 defined as severe disease 1.Management
Abstinence from alcohol is a crucial determinant of long-term outcomes 1.
Corticosteroids are the only available therapy with proven efficacy for patients with severe AH, providing a survival benefit at one month in 50%-60% of patients 1.
Strategies are needed to overcome barriers to treating alcohol use disorder (AUD) in patients with ALD and to promote integrated care models involving hepatology and addiction medicine 1.Key Recommendations
Corticosteroids are recommended for patients with severe alcohol-associated hepatitis 1. (Evidence: Strong)
Abstinence from alcohol use is a crucial determinant of long-term outcomes in alcohol-associated liver disease 1. (Evidence: Strong)
Multidisciplinary integrated care models involving hepatology and addiction medicine providers are needed for patients with alcohol-associated liver disease and alcohol use disorder 1. (Evidence: Expert opinion)References
1 Jophlin LL, Singal AK, Bataller R, Wong RJ, Sauer BG, Terrault NA et al.. ACG Clinical Guideline: Alcohol-Associated Liver Disease. The American journal of gastroenterology 2024. link