The American College of Gastroenterology (ACG) has released a new clinical guideline to address alcohol-associated liver disease (ALD), particularly in light of the increasing incidence of alcohol use disorder (AUD), which was exacerbated by the COVID-19 pandemic. The guideline, published in the American Journal of Gastroenterology, provides recommendations for managing ALD and AUD.
Key recommendations include avoiding alcohol consumption among individuals with underlying obesity, chronic hepatitis C infection, hepatitis B virus infection, or a history of gastric bypass. The guideline emphasizes the need for health systems to overcome barriers in treating AUD and to commit to creating a multidisciplinary care model that includes behavioral interventions and pharmacotherapy for patients.
The guideline was developed due to the rising incidence of alcohol use leading to a growing healthcare burden related to ALD. ALD is the most common cause of advanced hepatic disease and a frequent indicator of eventual liver transplantation. Patients with ALD often present at an advanced stage and progress faster, leading to progressive fibrosis, cirrhosis, and hepatocellular carcinoma.
The authors of the guideline analyzed data to form 34 key concepts or statements and 21 recommendations. They strongly recommend screening and treating AUD to help patients who have not yet developed significant liver injury and to prevent progression to advanced stages of ALD. This is particularly important for at-risk groups, including women, younger people, and Hispanic and American Indian patients.
The guidelines also provide recommendations for AH treatment, including strong recommendations against the use of pentoxifylline and prophylactic antibiotics, and in support of corticosteroid therapy and intravenous N-acetyl cysteine as an adjuvant to corticosteroids.
Liver transplantation is recommended for carefully selected patients, although it remains controversial. The guideline highlights the need for more research and a universal set of ethically sound, evidence-based guidelines for transplant centers.
The authors also note the importance of policy aimed at alcohol use reduction, multidisciplinary care for AUD and ALD, and additional research around severe AH. They hope the guidelines will inspire practitioners to explore their influence on how alcohol is regulated, marketed, and distributed.