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.


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
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