Alcoholic liver disease (ALD) comprises a clinical-histologic spectrum including fatty liver, alcoholic hepatitis (AH), and cirrhosis with its complications. Usually maximum number of patients are diagnosed at advanced stages and there is scarce data on the prevalence and profile of patients with early disease. Furthermore, prolonged abstinence is the most efficient method to prevent disease progression. The authors were invited by the Board of Trustees and Practice Parameters Committee of the American College of Gastroenterology (ACG), to develop this practice guideline on the management of patients with ALD.

Recommendations

1. Patients with obesity or chronic HCV should avoid intake of alcohol.
2. Patients with ALD are advised to abstain from cigarettes
3. Patients with heavy alcohol use (>3 drinks per day in men and >2 drinks in women) for >5 years) should be counselled that they are at an increased risk for liver disease.
4. Baclofen is successful in preventing alcohol relapse in patients with ALD.
5. Brief motivational interventions are efficient in reducing alcohol relapse in contrast to no intervention in patients with ALD.
6. Nutritional supplementation should be advised to ensure adequate caloric intake and to correct specific deficits in patients with AH, yet its effects on patient survival are still unestablished.
7. Patients with severe AH should be managed with corticosteroids, if there are no contraindications for their use.
8. The existing data does not support the use of pentoxifylline for patients with severe AH.
9. Liver transplantation (LT) can be considered for highly selected patients with severe AH.

Source: Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol. 2018;113(2):175-194.