From the Guidelines
The new name for Alcoholic Liver Disease (ALD) is indeed Alcohol-associated Liver Disease (ALD). This change in terminology, as suggested by the 2019 practice guidance from the American Association for the Study of Liver Diseases 1, aims to reduce the stigma associated with the condition by shifting the focus from the term "alcoholic" to "alcohol-associated". The term ALD encompasses a spectrum of liver injuries resulting from alcohol use, including hepatic steatosis, alcoholic hepatitis (AH), and alcohol-associated cirrhosis (AC) 1.
Key Points
- The name change from Alcoholic Liver Disease to Alcohol-associated Liver Disease reflects a more accurate and less stigmatizing description of the condition.
- ALD represents a spectrum of liver injury resulting from alcohol use, ranging from hepatic steatosis to more advanced forms including alcoholic hepatitis and cirrhosis.
- The updated terminology is part of a broader effort in medicine to use more precise and patient-centered language, as noted in the 2019 practice guidance 1.
- The pathophysiology of the disease remains unchanged, with alcohol and its metabolites causing direct hepatocyte damage, triggering inflammatory responses, and promoting oxidative stress in the liver.
- Treatment for ALD still focuses on alcohol cessation, nutritional support, and management of complications, regardless of the name change, as outlined in the guidance 1.
Clinical Implications
The change in terminology to Alcohol-associated Liver Disease is significant because it acknowledges the association between alcohol use and liver disease without stigmatizing the patient. This shift in language can encourage patients to seek medical help without fear of judgment, potentially leading to earlier diagnosis and treatment. As healthcare providers, using the term Alcohol-associated Liver Disease can help foster a more supportive and non-judgmental environment for patients struggling with alcohol use and related liver conditions, in line with the recommendations from the American Association for the Study of Liver Diseases 1.
From the Research
Definition and Terminology
- The term "Alcoholic Liver Disease (ALD)" is still widely used, but recent studies refer to it as "Alcohol-Associated Liver Disease" 2, 3, 4.
- This change in terminology reflects the complexity of the disease and its association with alcohol consumption.
Current Understanding
- Alcohol-Associated Liver Disease (ALD) encompasses a range of conditions, from steatosis to cirrhosis, and is a major cause of chronic liver disease 2, 3, 4.
- The disease is characterized by a clinical-histologic spectrum of presentations, including steatohepatitis, fibrosis, and cirrhosis 2, 3.
Diagnosis and Treatment
- Diagnosis of ALD requires documentation of chronic heavy alcohol use and exclusion of other causes of liver disease 5.
- Treatment options for ALD include abstinence, nutritional support, and corticosteroids, as well as management of underlying alcohol-use disorder 2, 3, 4, 5.
- Liver transplantation may be considered in selected patients with advanced cirrhosis or severe alcohol-associated hepatitis 3, 4, 5.