ACG Releases New Clinical Guideline for Management of Alcohol-Associated Liver Disease

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The American College of Gastroenterology (ACG) published a new clinical guideline highlighting the need to overcome barriers to alcohol use disorder (AUD) treatment and expand multidisciplinary care for patients with alcohol-associated liver disease (ALD).

“Healthcare burdens from AUD and ALD are significant in the United States and worldwide and are increasing in recent years. Providers in all clinical areas must be prepared to care for this growing population of patients,” wrote researchers in the American Journal of Gastroenterology.

While ALD often occurs in the setting of AUD, patients with ALD rarely receive treatment for AUD. Because of this, “strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD,” stated investigators.

First author Loretta Jophlin, MD, PhD, of the Division of Gastroenterology, Hepatology and Nutrition at the University of Louisville Health in Kentucky, and colleagues developed the practice guideline by performing a Grading of Recommendations, Assessment, Development and Evaluation analysis of data based on a patient-intervention-comparison-outcome format.

The analysis resulted in 34 key concepts or statements and 21 recommendations, which include the following:

• Avoidance of alcohol intake among patients with chronic hepatitis C virus infection and among patients with chronic hepatitis B virus infection.
• Patients with heavy alcohol use should abstain from tobacco use in any form due to the associated higher risk of cirrhosis.
• Use of brief screening tools, such as the Alcohol Use Disorders Identification Test-Consumption tool, in patients with screened for alcohol use.
• In patients with compensated ALD, baclofen is recommended for the treatment of AUD. They also suggested against the use of disulfiram for treatment of AUD along any spectrum of ALD.
• Pentoxifylline should not be used in patients with severe alcohol-associated hepatitis (AH), and universal administration of prophylactic antibiotics should not be performed in patients hospitalized with severe AH. Corticosteroid therapy and adjuvant IV N-acetylcysteine is recommended for those with severe AH.
• Use of integrated multidisciplinary care models that incorporate behavioral and/or pharmacotherapy for treatment of AUD in persons with ALD.

“With continued and increasing interest of researchers and funding organizations…there seems light at the end of the tunnel with a promising future to fill the knowledge gap in several unmet clinical needs in the field of ALD,” concluded Jophlin and colleagues.

“Policy aimed at alcohol use reduction, multidisciplinary care of the dual diagnoses of AUD and ALD, and refinement of LT algorithms for patients with severe AH are areas where research should be focused,” they added.

Source: Jophlin LL, Singal AK, Bataller R, et al. ACG clinical guideline: Alcohol-associated liver disease. Am J Gastroenterol. 2024;119:30-54. doi:10.14309/ajg.0000000000002572