Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Abstract

Alcoholic liver disease (ALD) represents a spectrum of liver injury resulting from alcohol use, ranging from hepatic steatosis to more advanced forms including alcoholic hepatitis (AH), alcoholic cirrhosis (AC), and acute alcoholic hepatitis presenting as acute on chronic liver failure (ACLF). ALD is a major cause of liver disease worldwide, both on its own and as a co-factor in the progression of chronic viral hepatitis, nonalcoholic fatty liver disease (NAFLD), iron overload and other liver diseases. ALD develops through several stages, beginning with hepatic steatosis, and, in some individuals, gradually progressing through alcoholic hepatitis (the histological correlate of which is alcoholic steatohepatitis), culminating in cirrhosis (Figure 1). Progression through these various stages is dependent upon continued heavy alcohol consumption and other risk factors, including female sex, genetic susceptibility, diet, and comorbid liver disease. ALD carries a significant stigma in society. It is increasingly recognized by providers that patients and their families seek to reduce the stigma of alcoholic liver disease, and a change from the term "alcoholic" to "alcohol-related" will help; thus, alcohol-related liver disease, alcohol-related steatohepatitis, and alcohol-related cirrhosis are suggested, retaining the familiar abbreviations (ALD, ASH, and AC, respectively). Due to longstanding usage, the term alcoholic hepatitis (AH) will likely persist. This article is protected by copyright. All rights reserved.