Alcohol-Associated Liver Disease: Integrated Management With Alcohol Use Disorder

Alcohol-associated liver disease (ALD) is the most common cause of cirrhosis and liver-related mortality in many re-gions worldwide. Around 75% of patients with cirrhosis are unaware of their disease until they are referred to the emergency department. An innovative, noninvasive screening approach is required for an earlier diagnosis of liver fibrosis. In patients with ALD the physician is inevi-tably dealing with 2 major disorders: the liver disease it-self and the alcohol use disorder (AUD). Focus only on the liver disease will inevitably lead to failure because tran-sient improvements in liver function are rapidly over-turned if the patient returns to alcohol consumption. For this reason, integrated models of care provided by hep-atologists and addiction specialists are an effective approach, which are, however, not widely available. There are multiple pharmacologic and non-pharmacologic ther-apies for AUD. Progress has recently been made in the management of patients with severe AH who have improved survival through better understanding of the concept of response to medical treatment, improved sur-vival prediction, and the advent of early liver trans-plantation. The emerging concept is that listing for transplantation a patient with severe ALD could lead to adjusting the duration of abstinence according to the severity and evolution of liver dysfunction and the pa-tient's addictive profile.