The American College of Gastroenterology has released clinical guidelines for the management of alcohol-associated liver disease (ALD) in a recent issue of the American Journal of Gastroenterology. The guidelines, developed by Dr. Loretta L. Jophlin and colleagues from the University of Louisville Health, address the rising healthcare burden associated with increased alcohol use over the past decade.
The guidelines highlight alcohol-associated hepatitis (AH) as a distinctive form of advanced ALD, characterized by rapid onset or worsening of jaundice and acute-on-chronic liver failure. Severe cases carry a one-month mortality risk of 20 to 50 percent, with the Model for End-Stage Liver Disease Score identified as the most accurate tool for stratifying AH severity.
Corticosteroids emerge as the only proven therapeutic option for severe AH, demonstrating a 50 to 60 percent survival benefit at one month. Achieving alcohol abstinence is particularly challenging for ALD patients with concurrent alcohol use disorder (AUD), and there is a noted gap in the treatment of AUD among ALD patients. The authors advocate for strategies to overcome barriers to treatment, emphasizing a multidisciplinary integrated care model involving hepatology, addiction medicine providers, and social workers.
For selected AH patients unresponsive to medical therapy and with a low risk of posttransplant alcohol use relapse, the guidelines suggest considering liver transplantation. The authors emphasize the need for research in areas such as alcohol use reduction policies, multidisciplinary care for dual diagnoses of AUD and ALD, and refining liver transplantation algorithms for severe AH patients. Additionally, the disclosure of financial ties to the pharmaceutical industry by several authors is noted.
