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#Gastroenterology #Hepatology #Multispeciality
Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the most frequent causes of chronic liver disease in both developing and developed countries. A rising trend in their incidence has also been observed, which is mainly attributed to widespread easy availability of alcohol and sedentary life style of people. The wide spectrum of NAFLD contains fatty liver (NAFL) which is considered benign disease, steatohepatitis (NASH) while, ALD spectrum includes simple steatosis, alcoholic hepatitis, and cirrhosis and its complications.
Majority patients suffering from NAFLD are asymptomatic and diagnosed with fatty liver while undergoing routine health check up. ALD requires history of alcohol intake, which is further verified by radiological, and biochemical tests. However, liver enzymes are seldom raised beyond five times the upper limit of normal in both NAFLD and ALD patients. These enzymes are ineffective tool for the diagnosis of patients with ALD as liver enzymes may or may not be raised and the elevation is not associated with severity of disease. However, the pattern of elevation is useful in making a diagnosis of liver injury due to alcohol as AST is usually two to three times greater than ALT in these patients. Another diagnostic tool is raised serum gamma-glutamyltranspeptidase (GGT) which is more than serum alkaline phosphatase level. In cases of advanced fibrosis or cirrhosis, low serum albumin, low platelet and high prothrombin time are typically seen.
Liver biopsy is generally not used for the diagnosis of ALD except when other comorbidities are associated like viral disease or NAFLD or diagnosis in doubt due to unclear history and laboratory findings. However, this diagnostic tool is essential for diagnosis of NASH and can also be used in alcoholic hepatitis for confirmation of diagnosis. Besides, non-invasive markers and prognostic scores have been developed to exclude liver biopsy in evaluation and treatment response in patients with 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;5:19. Published 2020 Apr 5.