Alcohol-associated liver disease (ALD) exhibits a spectrum of liver injury ranging from hepatic steatosis to more advanced forms including alcoholic hepatitis (AH), alcohol-associated cirrhosis (AC), and acute AH presenting as acute-on-chronic liver failure. It is also considered as a significant cause of liver disease globally, both on its own and as a co-factor in the progression of chronic viral hepatitis, nonalcoholic fatty liver disease (NAFLD), iron overload, and other liver diseases.

Practice Guidance from the American Association for the Study of Liver Diseases 2019 provides a data-supported approach to the prevalence, clinical spectrum, diagnosis, and clinical management of ALD and alcohol use disorders (AUDs). This was developed by consensus of an expert panel and offers guidance statements based on formal review and evaluation of published literature on the topics.

Recommendations for Diagnosis of Alcoholic Use Disorders

• Screening of all patients receiving care in primary care and gastroenterology/hepatology outpatient clinics, emergency departments, and inpatient admissions should be routinely done for alcohol use with the help of validated questionnaires.
• Patients engaged in hazardous drinking or binge drinkers should be offered a brief intervention, pharmacotherapy, and referral to treatment.
• Alcohol biomarkers can help in diagnosis and support recovery. Liver disease can not influence urine and hair ethyl glucuronide, urine ethyl sulfate, and phosphatidylethanol and thus, are preferable.

Source: Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. AASLD. January 2020;71(1). Available at: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.30866