Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the most common causes of chronic liver disease in the developing as well as the developed world. Increase in the incidence of these conditions can be attributed to the extensive and easy availability of alcohol and the sedentary lifestyle of people.

The NAFLD spectrum encompasses fatty liver (NAFL) which is a benign disease, steatohepatitis (NASH) which points to ongoing liver injury and liver cirrhosis. The ALD spectrum includes simple steatosis, alcoholic hepatitis, and cirrhosis as well as its complications.

There is a significant overlap between these diseases and the clinical presentation is based on the stage of liver disease. Most NAFLD patients are asymptomatic and are diagnosed as having fatty liver when undergoing a routine health checkup. ALD is associated with a significant history of alcohol intake, and is supported by radiological and biochemical tests.

In both the conditions, liver enzymes are seldom raised beyond five times the upper limit of normal. Liver biopsy helps in the diagnosis of NASH as it is primarily a histological diagnosis. A biopsy may sometimes be required in alcoholic hepatitis for confirmation if diagnosis is ambiguous.

We also have non-invasive markers and prognostic scores that help avoid a liver biopsy in the assessment and treatment response of NASH and alcoholic hepatitis.

Source: Sharma P, Arora A. Clinical presentation of alcoholic liver disease and non-alcoholic fatty liver disease: spectrum and diagnosis. Transl Gastroenterol Hepatol. 2020 Apr 5;5:19.