Management of alcohol‐related liver disease: the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines

Abstract

Excessive alcohol consumption is the leading cause of liver diseases in Western countries, especially in France. Alcohol‐related liver disease (ARLD) is an extremely broad context and there remains much to accomplish in terms of identifying patients, improving prognosis and treatment, and standardising practices. The French Association for the Study of the Liver wished to organise guidelines together with the French Alcohol Society in order to summarise the best evidence available about several key clinical points in ARLD. These guidelines have been elaborated based on the level of evidence available in the literature and each recommendation has been analysed, discussed and voted by the panel of experts. They describe how patients with ARLD should be managed nowadays and discuss the main unsettled issues in the field.

The French guidelines for alcohol-related liver disease—what’s new, what’s not and what’s still needed

“…The GRADE approach not only weighs each recommendation by supporting evidence, but also highlights where the gaps in our understanding remain. For example, since alcohol consumption is often underreported, continuous efforts to uncover the surreptitious harmful alcohol use in the general population are important aspects of all 3 guidelines ( 1 - 3 ). Recent work has suggested that biomarkers of alcohol consumption may be useful in screening the general population.…”

“…Louvet et al recently published the French Association for the Study of the Liver (AFEF) and the French Alcohol Society clinical guidelines ( 1 ). The AFEF guidelines are the first specific to the screening and care of alcohol-related liver disease (ALD) in France.…”

“… The order of comparison was based on the order of discussion and guidelines in the AFEF document ( 1 ). Some areas that were discussed in AASLD and/or EASL guidelines (e.g., management of alcohol-related cirrhosis) were not covered in the AFEF guidelines and therefore no comparison was made.…”

Principles of treatment of different forms of alcoholic liver disease: A review

“…Его определение и критерии диагностики усовершенствованы Национальным институтом изучения злоупотребления алкоголем и алкоголизма (National institute on alcohol abuse and alcoholism) в 2016 г. [8], и именно они указаны в клинических рекомендациях большинства стран [9][10][11][12]. АГ называют клиническую форму АБП с быстро развивающейся желтухой и повышением сывороточного уровня аспартатаминотрансферазы (АСТ), возникающими на фоне тяжелого злоупотребления алкоголем [8].…”

Alcohol‐related liver disease treatment and EBM

“…The unbalanced recommendation from France about alcohol-related liver disease claiming that 'The presence of liver disease does not generally affect the prescribing of baclofen at the doses recommended by the marketing authorization' deserved comment when considering the international impact of the Journal. 1 Indeed, baclofen use is off-label, except in France. The French Alcohol Society cannot ignore that the director of the French medicines' agency granted marketing approval despite the Special Scientific Committee concluding that the benefits/harms ratio was negative.…”