Subclinical versus advanced forms of alcohol-related liver disease: Need for early detection

Abstract

Alcohol-related liver disease (ALD) consists of a wide spectrum of clinical manifestations and pathological features, ranging from asymptomatic patients to decompensated cirrhosis and hepatocellular carcinoma. Patients with heavy alcohol intake and advanced fibrosis often develop a subacute form of liver failure called alcohol-induced hepatitis (AH). Globally, most patients with ALD are identified at late stages of the disease, limiting therapeutic interventions. Thus, there is a need for early detection of ALD patients, which is lacking in most countries. The identification of alcohol misuse is hampered by the existence of alcohol underreporting by many patients. There are useful biomarkers that can detect recent alcohol use. Moreover, there are several non-invasive techniques to assess the presence of advanced fibrosis among patients with alcohol misuse, which could identify patients at high risk of liver related events or early death. In this review, we discuss differences between early stages of ALD and AH as the cornerstone of advanced forms. A global overview of epidemiological, anthropometric, clinical, analytical, histological, and molecular differences is summarized in this article. We propose that campaigns aimed at identifying patients with subclinical forms can prevent the development of life-threatening forms.

Current and future treatment for alcoholic‐related liver diseases

“…The spectrum of ALD spans steatosis, fibrosis, and cirrhosis to hepatocellular carcinoma related to chronic alcohol abuse (more than 20 g/day in females and more than 30 g/day in males). 4 According to a systematic review, the annual rate of mortality in histologically proven steatosis is up to 6%, suggesting that even steatosis is not a benign condition compared to alcoholic steatohepatitis (11%) and cirrhosis (8%). 5 Nevertheless, steatohepatitis shows the highest rate (36%) of mortality attributed to liver disease among the conditions-25% and 17% in patients with cirrhosis and steatosis, respectively.…”

Alcohol consumption and the risk of liver disease: a nationwide, population-based study

“…It frequently affects the liver and results in alcohol-related liver disease (ALD) ( 11 , 12 ). ALD presents with a broad variety of clinical manifestations and pathological characteristics such as isolated steatosis, progressive steatohepatitis with fibrosis accumulation, cirrhosis, and related complications ( 13 ). Although several factors such as sex, age, race, nutrition, genetics, and pre-existing liver disease contribute to the development and progression of ALD, a history of excessive alcohol consumption remains an indispensable criterion for ALD diagnosis ( 14 ).…”