What is the treatment for alcoholic liver cirrhosis?

From the Guidelines

The primary treatment for alcoholic liver cirrhosis is complete abstinence from alcohol, which is essential to prevent further liver damage and improve survival. Patients should be referred to alcohol cessation programs and may benefit from medications like acamprosate, naltrexone, or disulfiram to support sobriety 1.

Key Recommendations

• Abstinence from alcohol is crucial to reduce the risk of liver-related complications and mortality 1
• Identification and management of cofactors, including obesity and insulin resistance, malnutrition, cigarette smoking, iron overload, and viral hepatitis, are recommended 1
• General recommendations for screening and management of complications of cirrhosis should be applied to alcoholic cirrhosis 1
• Nutritional therapy is crucial, with a high-protein (1.2-1.5 g/kg/day), high-calorie diet recommended to combat malnutrition 1
• Vitamin supplementation, particularly thiamine (100 mg daily), folate (1 mg daily), and multivitamins, helps address deficiencies
• For complications, specific treatments include:
  • Diuretics like spironolactone (starting at 100 mg daily) and furosemide (starting at 40 mg daily) for ascites 1
  • Propranolol or nadolol for varices prophylaxis
  • Lactulose (30-45 mL 2-4 times daily) and rifaximin (550 mg twice daily) for hepatic encephalopathy
• In advanced cases, liver transplantation may be considered for eligible patients who demonstrate sustained sobriety, typically 6 months 1 These interventions target the underlying cause of liver damage while managing complications that arise from portal hypertension and decreased liver function, ultimately aiming to improve quality of life and extend survival.

From the Research

Treatment for Alcoholic Liver Cirrhosis

The treatment for alcoholic liver cirrhosis involves several approaches, including:

• Prolonged abstinence from alcohol, which is crucial in the management and prognosis of the disease 2
• Prevention of complications such as variceal bleeding, hepatocellular and extrahepatic cancers, and malnutrition 2
• Consideration of liver transplantation in patients with persistent liver failure despite complete cessation of alcohol consumption 2, 3
• Use of corticosteroid therapy in select patients with severe alcoholic hepatitis, which can improve 1-month survival 3
• Use of beta-blockers, such as non-selective beta-blockers (NSBB), to lower portal pressure and reduce the risk of variceal bleeding 4
• Management of alcohol dependence using psychosocial interventions and medications, such as disulfiram, naltrexone, and acamprosate, to reduce alcohol intake and promote abstinence 5

Management of Alcohol Dependence

The management of alcohol dependence in patients with alcoholic liver disease is critical, and may involve:

• Achieving long-term total alcohol abstinence and preventing relapse 5
• Use of medications, such as topiramate, ondansetron, and baclofen, which have shown promise in reducing alcohol intake and promoting abstinence 5
• Use of drugs, such as silybin, metadoxine, and adenosylmethionine, which can help to prevent fibrotic evolution 6

Detection and Treatment of Alcoholic Liver Fibrosis

The detection and treatment of alcoholic liver fibrosis is also important, and may involve:

• Early detection of fibrosis using hepatic elastography 6
• Use of a detoxification program to achieve abstinence 6
• Use of drugs with antifibrotic effects, such as silybin, metadoxine, and adenosylmethionine, to prevent cirrhosis 6