22nd July 2023

Management

The first line treatment  – and most important intervention  – in the management of ALD is complete abstinence from alcohol.

In the earlier stages of the disease, abstaining from alcohol has the potential to reverse some of the damage that has occurred. For those with more advanced disease, including cirrhosis, there are survival benefits associated with abstinence. It is important to support people in their plans to stop drinking, as some may be at risk of alcohol withdrawal syndrome  – see Alcohol withdrawal syndrome section.

Other recommended lifestyle changes include smoking cessation and weight loss.

A multidisciplinary team approach to management is recommended, ideally with input from mental health services and a nutrition expert. People with ALD are highly likely to be malnourished and may require supplementation. This cohort of patients is at high risk of refeeding syndrome and should be monitored closely for this.

Patients should also be monitored and treated for other known complications of alcohol-related cirrhosis. This may include endoscopic surveillance for oesophageal varices and 6-monthly ultrasound scans  – with or without AFP serum measurement  – to screen for HCC.

Oesophageal varices may be managed with non-selective beta-blockers or endoscopic banding.

Ultimately, those with advanced disease should be considered for liver transplantation. There are criteria when considering if someone may be suitable for a transplant; this often includes a requirement for a period of abstinence and are generally specific to units.