alcohol-associated liver disease

Alcoholic liver disease (now known as alcohol-related liver disease or alcohol-associated liver disease) is an ancient condition with a documented epidemiology of more than 2500 years. In its end stage of cirrhosis it is the 3rd or 4th commonest cause of death in adults in the USA.

The threshold beyond which alcohol-related liver disease may occur is 35 units of alcohol per week for women and 50 units of alcohol per week for men. One unit of alcohol is equivalent to half of a pint of beer or one measure of spirits or 10 g of alcohol. Only the amount of alcohol, and not the nature of the beverage, is important

The exact mechanism of alcoholic hepatitis and cirrhosis is not known. Genetic factors may be important as only 10-20% of heavy drinkers develop cirrhosis, and 33% of heavy drinkers have no hepatic consequences.

Ethanol induces the synthesis of hepatic gamma glutamyl transferase (GGT)

• GGT levels become elevated after alcohol intake; its sensitivity and specificity are approximately 40-60 and 80-90%, respectively (1)

Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis, including in patients who have already progressed to high-risk portal hypertension (2)

Notes (3):

• the term “alcoholic” is pejorative and associated with significant stigma
  • has been recognized by specialists and specialist bodies, which have sought to address it through a change in terminology
    • European Association for Study of the Liver (EASL) has recommended use of the term “alcohol-related", while the American Associated for the Study of Liver Disease (AASLD) advocates the term “alcohol-associated"

Reference:

• (1) Torrente MP et al. Protein biomarkers of alcohol abuse. Expert Rev Proteomics. 2012 August ; 9(4): 425-436. doi:10.1586/epr.12.38.
• (2) Hofer BS et al. Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis. Clin Gastroenterol Hepatol. 2022 Dec 5:S1542-3565(22)01113-2.
• (3) Thursz M, Lingford-Hughes A. Advances in the understanding and management of alcohol-related liver disease BMJ 2023; 383 :e077090 doi:10.1136/bmj-2023-077090