Every patient presenting with the clinical features of hepatitis or chronic liver disease or demonstrating elevated serum transaminase levels must undergo screening for an alcohol use disorder. ALD diagnosis is greatly based on history, clinical and laboratory findings. But the scarcity of diagnostic tests to confirm the diagnosis and patients unwillingness to disclose the degree of alcohol consumption possesses great challenges in its clinical diagnosis. Furthermore, the absence of any clinical finding in early ALD (hepatic steatosis) further complicates the diagnosis. 

Typical laboratory findings in ALD are: Transaminase levels with aspartate aminotransferase > alanine aminotransferase, Increased mean corpuscular volume, Increased gamma-glutamyltranspeptidase, Increased IgA to IgG ratio. Imaging and liver biopsy can be utilized to get a clearer view in diagnosing. 

The histological features of ALD are typical presence and distribution of: Hepatic steatosis, Inflammation, Mallory-Denk bodies. 

Non-invasive methods like FibroScan and magnetic resonance elastography should be considered in diagnosing ALD, which can even diagnose early disease but their usage still needs to be evaluated in this condition.

Further, clinical and laboratory parameters serve an important purpose to predict the prognosis of ALD in more advanced and severe cases and further for determining the therapeutic approach. 

Since ALD can be reversed by observing sobriety, regular screening of the general population and early diagnosis is greatly essential.

ASH and alcoholic hepatitis still demand a unique, clear definition to explain their identity particularly in the presence of chronic liver disease or cirrhosis. ASH and alcoholic hepatitis in the spectrum of ALD represents a void in current research that warrants further investigation.

Source: Torruellas C, French SW, Medici V. Diagnosis of alcoholic liver disease. World J Gastroenterol. 2014;20(33):11684-11699. doi:10.3748/wjg.v20.i33.11684