Alcoholic liver disease diagnosis is suggested by an established history of habitual alcohol intake of sufficient length and intensity.
Signs of alcohol abuse and hepatic injury include malnutrition and muscle wasting, cutaneous telangiectasia, palmar erythema, finger clubbing, Dupuytren's contracture, peripheral neuropathy, parotid gland enlargement and signs of gynecomastia and hypogonadism may also be present. Patient may also be asymptomatic.


Alcohol-related%20liver%20disease Patient Education

Lifestyle Modification

Abstinence from Alcohol

  • Cornerstone of long-term management of alcohol-related liver disease (ALD)
  • Though the safe alcohol consumption level continues to be reviewed, patients with no liver disease should be advised to take no more than 2 standard drinks/day for males and no more than 1 standard drink/day for females   
    • Patients with ALD or other liver diseases (eg NASH, NAFLD, viral hepatitis and hemochromatosis) should be advised to completely abstain from alcohol
  • Educate the patient regarding the nature of the disease and the benefit of discontinuing alcohol intake
    • Abstinence or marked reduction in alcohol intake has been shown to improve histology and/or survival in all stages of ALD
      • Abstinence can cause total resolution of alcoholic steatosis and improve long-term prognosis in alcoholic hepatitis 
      • Risk of liver-related complications and mortality is reduced following complete alcohol abstinence in patients with alcohol-related cirrhosis  
  • Assistance should be given to the patient to help them change their behavior
    • Psychosocial and behavioral approaches may include counseling, group therapies or inpatient rehabilitation
    • Other modalities include cognitive behavioral therapy, motivational interviewing or motivational enhancement therapy
  • Patient may require consultation with a psychiatrist or addiction specialist
  • Disulfiram, Naltrexone and Acamprosate are approved abstinence and relapse prevention medications for patients with alcohol use disorder (AUD)  
    • Due to their potential for hepatotoxicity, Disulfiram and Naltrexone should be avoided in patients with ALD
  • Nalmefene is approved in Europe for reduction of heavy drinking in AUD and may be considered when abstinence is not feasible in patients with early-stage liver disease 
  • Baclofen is used in patients with moderate alcohol withdrawal symptoms and to prevent alcohol relapse in patients with advanced ALD
  • Benzodiazepines are used in patients with moderate and severe alcohol withdrawal syndrome 
    • Due to its potential for abuse and/or encephalopathy, benzodiazepines should not be given for >10-14 days

Other Lifestyle Modifications

Smoking Cessation

  • Smoking may increase rate of progression of fibrosis in ALD
  • Patients should be encouraged to stop smoking

Obese Patients

  • Body mass index (BMI) has been shown to be an independent risk factor for ALD development
  • Physical activity and exercise are encouraged in obese patients
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
4 days ago
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.