American College of Gastroenterology (ACG) has released its new Guideline for Management of Alcoholic Liver Disease.It has compiled evidence and issued recommendations on the evaluation, diagnosis, and treatment of alcoholic liver disease for Hepatologists, gastroenterologists, primary care clinicians.They have been published in American Journal of Gastroenterology.
Initial Evaluation of Patients for Significant Alcohol Use
- All patients who consume men who ingest >3 drinks/day and women who ingest >2 drinks/day should be properly counselled that they are at increased risk for ALD.
- Liver function tests and abdominal ultrasound should be carried out in all cases of suspected ALD.
- Liver biopsy for the diagnosis of ALDD should not be performed routinely.
Management of Alcoholic Hepatitis (AH)
Alcoholic Hepatitis ( AH) is a clinical diagnosis and a clinician must look for worsening of jaundice and liver-related complications He should document of chronic and heavy alcohol use upto 8 weeks prior to presentation.A total serum bilirubin >3 mg/dL, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >1.5 times the upper limit of normal (but <400 U/L), and an AST/ALT ratio >1.5 should also be recorded.
- The patient should be hospitalized and worked up to exclude infections in cases of severe AH (defined as a Maddrey’s score ≥32 or model for end-stage liver disease [MELD] score >20) to prevent kidney injury .
- If patient’s Lille score at day 7 is >0.45 in patient on corticosteroids to improve 30-day survival, corticosteroids should be discontinued.
- Early liver transplantation should be considered in selected patients not responding to corticosteroid therapy.
- Baclofen is effective in preventing alcohol relapse in patients with ALD.
Management of Alcohol-Related Cirrhosis
Assess liver transplantation candidacy while managing end-stage ALD.
- Do not base transplantation candidacy solely on 6-month alcohol abstinence, consider factors such as social support and need for rehabilitation.
- Patients too sick to undergo rehabilitation therapy might be considered for transplantation via exception pathways, depending on the transplant center.
The experts feel that there is a clinical unmet need to develop more effective and safer therapies for patients with ALDdespite all the advancements made in the field.
For further reference log on to:
Singal AK et al. Am J Gastroenterol 2018 Jan 16
Dr. Kamal Kant Kohli
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