Alcohol-Associated Liver Disease: Evolving Concepts and Treatments

Abstract

Alcohol is a prominent cause of liver disease worldwide with higher prevalence in developed nations. The spectrum of alcohol-associated liver disease (ALD) encompasses a diverse range of clinical entities, from asymptomatic isolated steatosis to decompensated cirrhosis, and in some cases, acute or chronic liver failure. Consequently, it is important for healthcare practitioners to maintain awareness and systematically screen for ALD. The optimal evaluation and management of ALD necessitates a collaborative approach, incorporating a multidisciplinary team and accounting for concurrent medical conditions. A repertoire of therapeutic interventions exists to support patients in achieving alcohol cessation and sustaining remission, with complete abstinence being the ultimate objective. This review explores the existing therapeutic options for ALD acknowledging geographical discrepancies in accessibility. Recent innovations, including the inclusion of alcohol consumption biomarkers into clinical protocols and the expansion of liver transplantation eligibility to encompass severe alcohol-associated hepatitis, are explored.

Fig. 1

Spectrum of alcohol-associated liver disease. Alcohol-associated liver disease exists on a clinical spectrum. After prolonged heavy alcohol consumption, patients almost universally develop alcohol-associated steatosis. This is asymptomatic and is reversible with cessation of drinking. With continued drinking, a proportion of patients progress to develop associated hepatic inflammation (steatohepatitis) that over time leads to fibrosis formation. Significant fibrosis can progress to cirrhosis and the associated sequelae of hepatitic decompensation and hepatoceullar carcinoma

Fig. 2

Multidisciplinary care of patients with alcohol-associated liver disease. Alcohol-associated liver disease is a complex mutifaceted condition that requires simultaneous consideration of comorbid liver disease, alcohol use disorder, mental illness, nutrition, and other psychosocial issues. It is best managed using an integrated model of care involving a broad range of health professionals