From the Guidelines
The European Association for the Study of the Liver (EASL) 2018 guidelines for managing alcohol-related liver disease recommend complete alcohol abstinence as the primary intervention for all patients. This is based on the most recent and highest quality evidence available, which prioritizes reducing alcohol consumption to improve morbidity, mortality, and quality of life outcomes in patients with alcohol-related liver disease 1.
Key Recommendations
- Complete alcohol abstinence is the primary intervention for all patients with alcohol-related liver disease
- Benzodiazepines, such as lorazepam or oxazepam, are the first-line treatment for alcohol withdrawal syndrome, particularly in patients with liver impairment
- Nutritional support is crucial, with a recommended daily protein intake of 1.2-1.5 g/kg and 35-40 kcal/kg
- For severe alcoholic hepatitis, prednisolone 40 mg daily for 28 days is recommended, with treatment response assessed at day 7 using the Lille score
- Patients with alcohol-related cirrhosis should receive standard cirrhosis care, including screening for varices and hepatocellular carcinoma
- Liver transplantation should be considered for eligible patients with end-stage liver disease, with most centers requiring 6 months of abstinence before listing
Multidisciplinary Care
Multidisciplinary care involving addiction specialists is essential for long-term management of alcohol-related liver disease. This approach addresses both the liver disease and the underlying alcohol use disorder, as continued alcohol consumption accelerates disease progression and worsens outcomes 1. Baclofen may be considered to support abstinence in patients with advanced liver disease, starting at 5 mg three times daily and gradually increasing as needed.
Prioritizing Outcomes
The EASL guidelines prioritize reducing morbidity, mortality, and improving quality of life outcomes in patients with alcohol-related liver disease. By recommending complete alcohol abstinence and providing guidance on management of alcohol withdrawal syndrome, nutritional support, and treatment of severe alcoholic hepatitis, the guidelines aim to improve patient outcomes and reduce the burden of alcohol-related liver disease on healthcare systems 1.
From the Research
Management of Alcohol-Related Liver Disease
The management of alcohol-related liver disease involves a combination of treatments, including:
- Achieving long-term total alcohol abstinence and preventing relapse 2
- Psychosocial interventions and medications to reduce alcohol intake and promote abstinence 2
- Use of medications such as disulfiram, naltrexone, and acamprosate to reduce alcohol craving and prevent relapse 2
- Consideration of liver transplantation in patients with advanced liver disease who do not respond to medical therapy 3, 4
Treatment Options
Various treatment options are available for alcohol-related liver disease, including:
- Baclofen, which has been shown to be effective in promoting alcohol abstinence in patients with liver cirrhosis 5
- Corticosteroid therapy, which can improve survival in patients with severe alcoholic hepatitis 4
- Liver transplantation, which is the most effective therapy for patients with decompensated liver disease 4
- Targeted therapies to interfere with the pathogenesis of alcohol-related liver disease, although currently there are no approved therapies for this indication 3
Importance of Alcohol Abstinence
Alcohol abstinence is a crucial aspect of managing alcohol-related liver disease, as:
- Continued alcohol consumption can increase the risk of severe consequences, including mortality 2
- Alcohol abstinence can improve prognosis in patients with alcohol-related liver disease 3, 6, 4
- Ten-year survival rates are higher in patients who are abstinent compared to those who relapse to alcohol consumption 4