Behavioral Treatment for Patients With Alcohol‐Related Liver Disease: A Primer for Hepatologists

Ting, Peng–Sheng; Wheatley, Jason; Chen, Po Hung

doi:10.1002/cld.854

Cited by 8 publications

(5 citation statements)

References 13 publications

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Section: Discussionmentioning

confidence: 99%

“…This underscores the importance of screening for underlying ALD, particularly in those at risk for advanced disease or fibrosis. Patients who develop ALD require treatment for underlying AUD, with the primary goal of achieving abstinence (Ting et al., 2020). Approximately 10%–15% of AUD patients develop alcohol‐associated cirrhosis and the mortality rate from alcohol‐associated cirrhosis only affects a subset of patients with AUD (Schwantes‐An et al., 2021).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical features of individuals with laboratory values suggestive of advanced liver fibrosis when first treated for alcohol use disorder

Zuluaga,

Fuster,

Blanes

et al. 2024

Alcohol, Clinical and Experimental Research

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BackgroundEffective screening for alcohol‐associated liver disease is relevant in the context of chronic, excessive alcohol consumption. Patients with alcohol‐associated liver disease are often not diagnosed until their liver disease is decompensated. We analyzed the prevalence and associations of Fibrosis‐4 index (FIB‐4) values suggestive of advanced liver fibrosis in patients referred for their first treatment of alcohol use disorder (AUD).MethodsWe conducted a cross‐sectional, multicenter study of noncirrhotic individuals referred for their first AUD treatment between March 2013 and April 2021. We obtained sociodemographic data, substance use characteristics, and blood samples at admission. We considered a FIB‐4 value ≥2.67 suggestive of advanced liver fibrosis and used logistic regression analyses to identify features associated with this value.ResultsWe included 604 patients (67% male), with a median age at admission of 48 years [IQR: 41–56 years]. The median duration of regular alcohol consumption was 21 years [IQR: 18–30 years] and the median alcohol consumption was 105 standard drink units (SDU)/week [IQR: 63–160 SDU/week]. A FIB‐4 value ≥ 2.67 was present in 19.3% of cases. These patients reported more frequent binge drinking (75.4% vs. 66%, p = 0.05) than those with FIB‐4 values below 2.67. In multivariate analysis, a history of binge drinking (OR 1.9, 95% CI, 1.05–3.47), anemia (OR 2.95, 95% CI, 1.42–6.11), leukopenia (OR 7.46, 95% CI, 2.07–26.8), and total serum bilirubin >1 mg/dL (OR 6.46, 95% CI, 3.57–11.7) were independently associated with FIB‐4 values ≥2.67.ConclusionsOne in five patients admitted to treatment for AUD without evidence of decompensated liver disease have FIB‐4 values suggestive of advanced liver fibrosis. The presence of a binge drinking history, anemia, leukopenia, and elevated bilirubin levels is associated with high FIB‐4 values.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical features of individuals with laboratory values suggestive of advanced liver fibrosis when first treated for alcohol use disorder

Zuluaga,

Fuster,

Blanes

et al. 2024

Alcohol, Clinical and Experimental Research

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“…While we recognize the immense difficulty of achieving sobriety in alcohol use disorder, patients undergoing treatment for ALD are provided multiple well-validated resources for effective treatment of alcohol use disorder, including well-established, freely available modalities such as Alcoholics Anonymous, with over 123,000 available chapters and 2 million members worldwide. [15,16] In contrast, patients with NASH face substantial barriers. At present, there are no validated weight loss programs or medications for patients with decompensated NASH cirrhosis, and treatment relies on specialized centers and experimental therapeutics.…”

Section: The Challenges and Dangers Of Weight Loss In Nashmentioning

confidence: 99%

“…Weight loss in NASH has been likened to sobriety in ALD as a proxy for compliance; however, we believe this is an unfair and inappropriate comparison. While we recognize the immense difficulty of achieving sobriety in alcohol use disorder, patients undergoing treatment for ALD are provided multiple well-validated resources for effective treatment of alcohol use disorder, including well-established, freely available modalities such as Alcoholics Anonymous, with over 123,000 available chapters and 2 million members worldwide 15,16 . In contrast, patients with NASH face substantial barriers.…”

Section: The Challenges and Dangers Of Weight Loss In Nashmentioning

confidence: 99%

Which patient should be prioritized for liver transplant: NAFLD?

Manfready,

Rzepczynski,

Janardhan

2024

Clinical Liver Disease

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“…Provision of behavioural treatment can be through brief interventions, motivational interviewing, cognitive behavioural therapy (CBT) or motivational enhancement therapy [ 71 ]. CBT has the most consistent evidence for increasing abstinence in ALD, although data are limited [ 60 , 72 ].…”

Section: Management Of Aldmentioning

confidence: 99%

Alcohol-Associated Liver Disease: Evolving Concepts and Treatments

Prince,

Nash,

Liu

2023

Drugs

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Alcohol is a prominent cause of liver disease worldwide with higher prevalence in developed nations. The spectrum of alcohol-associated liver disease (ALD) encompasses a diverse range of clinical entities, from asymptomatic isolated steatosis to decompensated cirrhosis, and in some cases, acute or chronic liver failure. Consequently, it is important for healthcare practitioners to maintain awareness and systematically screen for ALD. The optimal evaluation and management of ALD necessitates a collaborative approach, incorporating a multidisciplinary team and accounting for concurrent medical conditions. A repertoire of therapeutic interventions exists to support patients in achieving alcohol cessation and sustaining remission, with complete abstinence being the ultimate objective. This review explores the existing therapeutic options for ALD acknowledging geographical discrepancies in accessibility. Recent innovations, including the inclusion of alcohol consumption biomarkers into clinical protocols and the expansion of liver transplantation eligibility to encompass severe alcohol-associated hepatitis, are explored.

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Behavioral Treatment for Patients With Alcohol‐Related Liver Disease: A Primer for Hepatologists

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-1-reading-ting a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-1-interview-ting an interview with the author

Cited by 8 publications

References 13 publications

Clinical features of individuals with laboratory values suggestive of advanced liver fibrosis when first treated for alcohol use disorder

Clinical features of individuals with laboratory values suggestive of advanced liver fibrosis when first treated for alcohol use disorder

Which patient should be prioritized for liver transplant: NAFLD?

Alcohol-Associated Liver Disease: Evolving Concepts and Treatments

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