Integrated Multidisciplinary Management of Alcohol-associated Liver Disease

Abstract

Alcohol-associated liver disease (ALD) is one of the most common liver diseases and indications for liver transplantation (LT). Alcohol use disorder (AUD), a frequent accompaniment in ALD patients, may also be associated with psychiatric comorbidities such as depression and anxiety. Identification of ALD at an earlier stage, and treatment of AUD may help prevent progression to advanced stage of ALD such as cirrhosis and alcoholic hepatitis. Screening for alcohol use and AUD treatment in ALD patients is often not performed due to several barriers at the level of patients, clinicians, and administrative levels. This review details the integrated multidisciplinary care model especially on the specific role of the hepatologist, psychiatrist, addiction counselor, and social worker in providing complete management for the dual pathology of liver disease and of AUD. Laboratory assessment, pharmacological and behavioral therapies, and recommended assessments for follow-up care by the respective specialists is outlined. We provide perspective along with the literature support, with the goal of providing team based comprehensive care of patients with ALD.

Keywords: Alcohol; Anxiety; Cirrhosis; Depression; Liver transplant; Multidisciplinary.

Fig. 1. Assessment by liver specialist on patients with alcohol use disorder and liver disease.

Decompensation includes one or more of ascites, hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma; enhanced liver fibrosis (ELF) score incorporating an algorithm using special laboratory evaluation for serum hyaluronic acid, tissue inhibitor of metalloproteinase, and procollagen III amino terminal peptide. AH, alcoholic hepatitis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; FIB-4, fibrosis-4 score (patient’s age, AST, ALT, platelet count); HTN, hypertension; LT, liver transplant; MRE, magnetic resonance elastography; MELD-Na, model for end-stage liver disease-sodium score (algorithm including serum total bilirubin, serum creatinine, institutional normalized ratio, and serum sodium); USG, ultrasonography.

Fig. 2. Definition of an alcohol-containing drink.

Source: https://www.niaaa.nih.gov/sites/default/files/standard-Drink-June2022.jpeg.