MDCalc

Alcoholic Liver Disease

Official guideline from the American College of Gastroenterology.

Environmental and Genetic Determinants

Environmental and Genetic Determinants
Conditional recommendation
Very low quality evidence
Patients with obesity or chronic HCV should avoid consumption of alcohol.
Conditional recommendation
Very low quality evidence
Patients with ALD should be advised to abstain from cigarettes.

Diagnosis of Alcoholic Use Disorder

Diagnosis of Alcoholic Use Disorder
Strong recommendation
Low quality evidence
Patients who have heavy alcohol use (>3 drinks per day in men and >2 drinks in women) for >5 years) should be counseled that they are at increased risk for alcoholic liver disease.

Management of Alcoholic Liver Disease

Management of Alcohol Use Disorder
Conditional recommendation
Low quality evidence
In patients with ALD, baclofen is effective in preventing alcohol relapse.
Conditional recommendation
Very low quality evidence
In patients with ALD, brief motivational interventions are effective in reducing alcohol relapse compared with no intervention.

Alcoholic Hepatitis

Treatment of Alcoholic Hepatitis
Conditional recommendation
Very low quality evidence
Patients with AH should be considered for nutritional supplementation to ensure adequate caloric intake and to correct specific deficits, yet its effects on patient survival has not been proven.
Strong recommendation
Moderate quality evidence
Patients with severe AH should be treated with corticosteroids if there are no contraindications for their use.
Conditional recommendation
Low quality evidence
The existing evidence does not support the use of pentoxifylline for patients with severe AH.

Liver Transplantation in Alcoholic Liver Disease

Liver Transplantation in Alcoholic Liver Disease
Strong recommendation
Moderate quality evidence
Liver transplantation may be considered for highly selected patients with severe AH.
Literature
Original/Primary Reference
Research PaperSingal AK, Bataller R, Ahn J, Kamath PS, Shah VH. Acg clinical guideline: alcoholic liver disease. American Journal of Gastroenterology. 2018;113(2):175-194.