The article on Healio discusses the new clinical guideline published by the American College of Gastroenterology (ACG) in the American Journal of Gastroenterology for the management of alcohol-associated liver disease (ALD). Key points from the guideline include:
Avoidance of Alcohol Consumption: The guideline emphasizes that individuals with underlying obesity or chronic hepatitis C and B virus infection should avoid alcohol consumption. Additionally, those who have undergone or have a history of gastric bypass surgery should avoid heavy alcohol use.
Screening and Treatment Recommendations: It recommends screening adults with suspected unhealthy alcohol use using tools like the Alcohol Use Disorders Identification Test-Consumption tool. For patients with compensated ALD and alcohol use disorder (AUD), treatments such as baclofen, acamprosate, naltrexone, gabapentin, or topiramate are recommended, while disulfiram is advised against.
Management of Severe Alcohol-Associated Hepatitis: The guideline advises against the use of pentoxifylline in patients with severe alcohol-associated hepatitis (AH) and discourages the universal administration of prophylactic antibiotics in hospitalized patients. However, corticosteroid therapy and adjuvant IV N-acetylcysteine are recommended for severe AH. In cases where patients with severe AH are unresponsive to medical management and at high risk of death, early liver transplantation may be considered.
Multidisciplinary Care Model: The guideline underscores the importance of an integrated multidisciplinary care model that includes behavioral interventions and/or pharmacotherapy for patients with ALD and AUD. This approach involves comprehensive care by specialists, including addiction experts, counselors, social workers, and psychiatrists, to overcome barriers to receiving care for alcohol use disorder and potentially improve long-term outcomes.
Dr. Ashwani K. Singal, a guideline author and professor of medicine, highlights the need for a multidisciplinary integrated care approach and the importance of treating alcohol use disorder effectively in these patients. He also notes the potential for future clinical trials in drug development to evaluate outcomes targeted at liver disease as well as alcohol use.