Alcohol-related liver disease

Alcohol abstinence can prevent development of ARLD. Alcohol consumption should especially be avoided by people with obesity, those with chronic hepatitis B or C infections, and those who have had gastric bypass surgery.[1]Jophlin LL, Singal AK, Bataller R, et al. ACG clinical guideline: alcohol-associated liver disease. Am J Gastroenterol. 2024 Jan 1;119(1):30-54. https://journals.lww.com/ajg/fulltext/2024/01000/acg_clinical_guideline__alcohol_associated_liver.13.aspx http://www.ncbi.nlm.nih.gov/pubmed/38174913?tool=bestpractice.com ​ Individuals with heavy alcohol consumption should avoid tobacco in any form as they have higher risk of cirrhosis.[1]Jophlin LL, Singal AK, Bataller R, et al. ACG clinical guideline: alcohol-associated liver disease. Am J Gastroenterol. 2024 Jan 1;119(1):30-54. https://journals.lww.com/ajg/fulltext/2024/01000/acg_clinical_guideline__alcohol_associated_liver.13.aspx http://www.ncbi.nlm.nih.gov/pubmed/38174913?tool=bestpractice.com

Social support through Alcoholics Anonymous, inpatient and outpatient rehabilitation programmes, and individual counselling should be provided to alcohol-dependent patients.

Social support through Alcoholics Anonymous, inpatient and outpatient rehabilitation programmes, and individual counselling should be provided to alcohol-dependent patients. All patients with ARLD should be screened for:

• Hepatitis A total or IgG antibodies

• Hepatitis B surface antibodies and hepatitis B core total and IgG antibodies

• Hepatitis C antibodies

If patients are not immune, they should be vaccinated against hepatitis A. The Advisory Committee on Immunization Practices in the US recommends that all adults aged 19-59 years, and adults aged 60 years and older with ARLD, should be vaccinated against hepatitis B.​[162]Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2025​. Nov 2024 [internet publication]. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html ​​​ If the patient has active hepatitis C or fulfils criteria for therapy for hepatitis B, they should be offered treatment. Immunisation against Pneumococcus and influenza is also advisable. If cirrhosis is present, screening for development of liver cancer is also recommended. Weight reduction in people with obesity and smoking cessation are both influential and positive steps towards reducing the risk and progression of ARLD. 

All medications should be evaluated for potential hepatotoxicity. If a medication may be hepatotoxic, an alternative drug should be considered. Caution and close observation is recommended if hepatotoxin use is absolutely necessary. Patients should be made aware of symptoms of liver injury. Periodic liver-related biochemical tests should be obtained at baseline before starting hepatotoxins, followed by every 2 weeks for the first month, every month for the next 3 months, and every 3 months thereafter. Hepatotoxic medication should be discontinued if measured laboratory values increase to >2 times the baseline levels or the patient develops liver-related symptoms.[163]Speeg KV, Bay MK. Prevention and treatment of drug-induced liver disease. Gastroenterol Clin North Am. 1995 Dec;24(4):1047-64. http://www.ncbi.nlm.nih.gov/pubmed/8749911?tool=bestpractice.com Patients with ARLD should be asked specifically about their use of alternative therapies. Patients should be instructed to avoid potentially hepatotoxic herbal preparations.

Patients with ARLD can safely use paracetamol at a dosage of up to 2 g/day, if they are eating regularly. Patients with ARLD with cirrhosis should avoid using non-steroidal anti-inflammatory drugs (NSAIDs), owing to enhanced nephrotoxicity and worsening of ascites.