Alcohol-Induced Liver Disease

Jennifer Cahill MD and Kaitlin Wanta DO

Loyola University Medical Center Dept. of Hepatology and Liver Disease

1 WHAT IS THE DISEASE? 3 RISK FACTORS & PREVENTION 5 TREATMENT

• Age (40-50y) Alcohol Avoidance
• Alcoholic liver disease (ALD) is a term which encompasses the manifestations
• Improves survival at all stages of liver disease
of alcohol overconsumption in the liver • Gender (F > M)
• Intensive outpatient programs
Fatty Liver (steatosis) • Race and ethnicity • Relapse rates ~ 70% at 1 year
Alcoholic Hepatitis (AH) • Obesity Nutrition
Liver Fibrosis • Protein calorie malnutrition • Nearly all patients with ALD have some degree of malnutrition
• Drinking patterns and type • Poor nutrition decreases survival
Cirrhosis
Alcoholic Hepatitis Specific Treatment
• Alcohol remains the second most common cause of cirrhosis in the US • Hepatitis C virus
• AVOID ALCOHOL
• Genetics • Prednisolone (steroid therapy)
• Helps reduce liver inflammation
Prevalence of Binge Drinking
• No survival benefit with Pentoxifylline, Milk Thistle, Vitamin E
Among US Adults, 2015.
Binge drinking is defined as 4 Liver Transplantation
or more drinks for a woman or • Documented sobriety for 6 months
5 or more drinks for a man. • Similar survival compared to other causes of cirrhosis

4 DIAGNOSIS & SCREENING Steatosis Hepatitis Cirrhosis

Combination of documented alcohol abuse and evidence of liver disease

History Physical Exam

Progression of alcoholic liver disease

• 44% of all deaths from liver disease were attributed to alcohol in the US
• Alcohol remains the 3rd most common preventable cause of death in the US
• Alcoholic cirrhosis remains the 2nd most common indication for liver Liver biopsy findings in alcoholic liver disease

6 RECENT ADVANCEMENTS
transplantation

CAGE screening questionnaire for alcohol abuse

Potential Targeted Therapy for Alcoholic Hepatitis
Laboratory Data
• No available test specific for alcohol abuse Medications
• Abnormal liver enzymes (AST, ALT) • Probiotics
• Abnormal liver function (INR, Total Bilirubin, Albumin) • Zinc
Imaging • Antibiotics
• Abdominal ultrasound, CT, MRI • Anti-inflammatory medications
• Fatty liver, nodularity, ascites, hepatosplenomegaly Early Liver Transplantation
Exam findings in chronic liver disease
• Not standard of care
• Selective screening is crucial
• Failure to respond to steroids
• Ethically controversial
Alcohol consumption and incidence of cirrhosis of the liver in men (m) and • Severity of disease may not allow for 6 month sobriety
women (w) • Survival benefit

2 DISEASE BURDEN
• Comparable graft outcomes
• Small percentage of alcohol relapse

• 60% of people in the US report drinking alcohol REFERENCES

• Alcohol use of more than 60 g/day is considered heavy drinking
Singal, et al. Clinical Liver Diseaes (2013).
• 90% - 100% have fatty liver Sacks, et al. Am J Prev Med (2015).
• 10% - 35% have alcoholic hepatitis AASLD.org
• 8% - 20% have alcoholic cirrhosis U.S. Department of Health and Human Services
• Cirrhosis can result from a minimum intake of 30 g/day of alcohol in women Pageaux, et al. Gut (1999).
and 50 g/day in men consumed over 5 years One standard drink contains 14 grams of alcohol Safe limits to alcohol use Liang, et al. World Journal of Gastroenterology (2015).
Shasthry, et al. World Journal of Gastroenterology (2016).