Alcohol-related liver disease Treatment

In a study of patients with mild to moderate alcoholic hepatitis, 1000 IU of vitamin E per day improved serum hyaluronic acid but had no beneficial effects on tests of liver function or mortality when compared with placebo [Mezey et al. 2004]. These treatment approaches for alcohol use disorder help patients, including those with alcoholic liver disease, reduce alcohol consumption, achieve abstinence and prevent relapse. Integration of addiction medicine into the multidisciplinary teams that care for these patients may improve outcomes. Baclofen, gabapentin, ondansetron, topiramate and varenicline have no evidence of liver toxicity, therefore they might also be useful in patients with alcohol use disorder and alcoholic liver disease (see Table 6 for details).

Of note, liver transplantation without the 6-month abstinence requirement has been used to treat patients with severe, acute alcoholic hepatitis who fail to respond to steroid therapy(71, 72). Liver transplantation in this population results in long-term survival benefits with recidivism to drinking at rates comparable or below those liver transplant patients who were required to have 6 months abstinence. For an extensive review on the management of alcohol use disorder in patients requiring liver transplant, see(68).


A pilot study examining the benefits of PTX in ASH, published in 1991, demonstrated that PTX could reduce mortality and HRS when compared with placebo [McHutchison et al. 1991]. The results were then duplicated in a double-blind placebo-controlled trial, which compared the effect of PTX (400 mg orally three times a day for 4 weeks) versus placebo symptoms of alcohol related liver disease in 101 patients with ASH (DF ≥ 32). Patients who received PTX had a decreased 28-day mortality compared to those who received placebo (24.5% versus 46%). Importantly, of those patients who died during the study, 50% of those in the PTX arm developed HRS, while 91.7% of patients who died in the placebo arm developed HRS [Akriviadis et al. 2000].

treatment of alcoholic liver disease

In the US, acamprosate, disulfiram and naltrexone (oral and intramuscular) are approved by the Food and Drug Administration (FDA) for treatment of alcohol use disorder. A recent meta-analysis supports the efficacy of naltrexone and acamprosate, but not disulfiram, for alcohol use disorder(60). Efforts have also been made to test other pharmacotherapies as potential new treatments for alcohol use disorder. These medications are FDA-approved for other indications, some of them have shown efficacy for alcohol use disorder in Phase 2/3 trials, but are not FDA-approved for alcohol use disorder.

Alcoholic Liver Disease

It is a chronic disease where the patient is unable to control alcohol use despite negative personal, occupational, or health effects. It can also be relapsing, meaning symptoms may return after having been gone for some time. Rates of AUD and high‐risk drinking behavior are increasing, especially among women, minorities, and those of lower socioeconomic status. In October of 2009, a meta-analysis of five trials studying the effect of PTX versus control, with a total of 336 randomized participants, was published. The statistical analysis of these trials indicated a possible positive intervention effect of PTX on all-cause mortality and mortality due to hepatorenal syndrome, and conversely, an increase in serious and nonserious adverse events. Four of the five trials were judged to have a high risk of bias, thus risking an overestimated intervention effect.

  • Only 24% of problem drinkers will actively seek assistance, and just 13% will receive specialized addiction treatments.
  • The consortia have been active for 4 or 5 years and have published some preliminary findings thus far.
  • Most importantly, a randomized, double-blind trial was performed in 123 patients with alcoholic cirrhosis treated using SAM (1200 mg/day, orally) or placebo for 2 years.
  • Acute alcoholic hepatitis can develop after as few as four drinks for women and five drinks for men.
  • Together, these results indicated that AF6 promotes inflammation and cell death in most liver diseases, including acute liver injury, non-alcoholic steatohepatitis (NASH) and the systemic inflammatory response syndrome (SIRS).

However, these abate with abstinence, usually within a month, though there is a protracted abstinence syndrome that can persist for months(81). This may be particularly challenging in those patients with alcohol use disorder and HCV infection who are taking DAAs, which are substrates as well as inhibitors of cytochrome P450 3A4 and P-glycoprotein. Indeed, the Matching Alcoholism Treatments to Client Heterogeneity (MATCH) trial(51) showed that they are equivalent. Similarly, the United Kingdom Alcohol Treatment Trial compared social/network therapy to MET and found no difference in outcome(52). The large Combining Medications and Behavioral Interventions (COMBINE) study examined whether combining medications and a behavioral intervention improves drinking outcomes in patients with alcohol use disorder(53).

Data Availability Statement

No alternative medicine therapies have been proved to treat liver disease. Some studies have indicated possible benefits, but further research is needed. Finding the cause and extent of liver damage is important in guiding treatment. Your doctor is likely to start with a health history and thorough physical examination. Sign up for free, and receive liver transplant and decompensated cirrhosis content, plus expertise on liver health.

  • If you have cirrhosis, your health care provider is likely to recommend regular tests to see if liver disease has progressed or check for signs of complications, especially esophageal varices and liver cancer.
  • While more data are required, the benefit of OLT in patients with severe ASH who fail to respond to corticosteroids is a promising area of research.
  • If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for a period of time (this could be months or years).
  • People with signs of malnourishment may need to increase the number of calories and amount of protein they consume, as well as take nutrient or vitamin supplements.
  • People who don’t stop drinking are likely to develop a variety of life-threatening health problems.

As a consequence, there are no safe levels of alcohol consumption in HCV-infected individuals, therefore alcohol abstinence is necessary for optimal treatment of HCV infection, especially in this new era of effective treatments for HCV. Alcohol abstinence is the first line of treatment, with periodic liver enzyme tests to monitor ongoing liver damage. Given the reluctance of patients to be open with regard to their alcohol use, biomarkers to reliably detect problematic drinking have been investigated extensively.

The most sensitive and specific indicator of recent alcohol use is the blood or breath alcohol test. This modality of testing has been found to be especially useful in binge drinkers [Savola et al. 2004]. Of course, blood or breath testing is limited by the relatively short half-life of ethanol in the breath, blood and urine and will not detect those patients who have not recently had alcohol intake. Among other biomarkers studied are carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT). In multiple studies GGT levels have proven to be more sensitive than CDT or alanine transaminase (ALT). However, specificity is very low and values are affected by multiple other factors including age, obesity and diabetes.

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