Gastroenterology & Nutrition

Alcohol-related Liver Disease

Alcohol-related liver disease ranges from reversible steatosis through alcohol-related hepatitis to cirrhosis; assess both the liver stage and alcohol-use disorder because abstinence, nutrition and specialist care change prognosis at every stage.

Definition

Alcohol-related liver disease is liver injury caused or contributed to by alcohol, spanning steatosis, alcohol-related hepatitis and cirrhosis. Assessment must address the stage of liver disease and the coexisting alcohol-use disorder.

First principles

Alcohol-related liver disease is a spectrum, not one diagnosis

Steatosis is fat accumulation and may improve with abstinence. Alcohol-related hepatitis is an acute inflammatory syndrome with jaundice and hepatocellular injury, often on a background of chronic disease. Cirrhosis is advanced architectural scarring with portal hypertension and loss of synthetic function. A person can move between stages or present with acute-on-chronic liver failure, so the clinical stage and complications must be assessed rather than inferred from alcohol history alone.

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