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
- Abstinence or marked reduction in alcohol intake has been shown to improve histology and/or survival in all stages of ALD
- 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