Expert consensus on the diagnosis and management of alcoholic liver disease

Abstract

Alcoholic liver disease (ALD) is a spectrum of liver injuries caused due to harmful use of alcohol. It is the primary cause of liver disease and is responsible for around 4% of mortality worldwide. ALD progresses from fatty liver to alcoholic hepatitis depending upon risk factors, such as continued alcohol consumption or comorbid liver diseases. Screening and diagnosis are suggested for patients with histological symptoms and in high-risk populations. Management of ALD includes strategies such as abstinence from alcohol consumption, nutrition therapy, pharmacological therapy, and liver transplantation, with alcohol abstinence being the most beneficial to reverse fatty liver conditions. Various novel treatment approaches having distinct mechanisms of action are also developed besides conventional corticosteroid therapy, which include microbiota-based precision medicine, monoclonal antibody therapy, hepatocyte regeneration therapy, epigenetic modulators, liver degeneration boosters, and targeting the gut-liver axis. Ursodeoxycholic acid (UDCA) has shown to benefit ALD patients with cholestasis by exerting biochemical improvements; hence, it can be considered as an adjunct therapy. National and regional advisory board meetings were conducted to discuss the current diagnostic and management techniques, including existing and novel pharmacological treatments available for ALD along with current clinical practices in India.