Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Abstract

PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in Western Nepal

“…[6] Definitions of other parameters like HE, spontaneous bacterial peritonitis, hepatorenal syndrome, etc. were taken from current medical diagnosis and treatment.…”

“…[5] Moreover, both laboratory abnormalities and physical findings may be minimal or absent even in patients with established ALD. [6]…”

“…Although liver biopsy is the gold standard in the diagnosis of ALD,[6] it is rarely performed in clinical practice. This is because a combination of clinical and laboratory data can make an accurate diagnosis of ALD with the prebiopsy diagnosis of ALD being 98% specific and 79% sensitive.…”

A Recent Perspective on Alcohol, Immunity, and Host Defense

“…It is generally accepted that alcohol use worsens the clinical outcome of any types of viral hepatitis, particularly chronic infections with hepatitis B (HBV) or hepatitis C virus (HCV) in humans (McCullough et al, 1998; Szabo and Marshal, 2008). Chronic hepatitis C virus (HCV) infection and alcohol use are the two most common causes of chronic liver diseases in the United States and both are recognized as major causes of liver disease worldwide.…”

“…Alcoholic liver disease (ALD) is a major heath consequence of chronic alcohol use and approximately 44% of the 26,000 deaths from cirrhosis are due to alcoholic liver disease in the United States (McCullough et al, 1998). Activation of the inflammatory cascade is a key element in alcoholic liver disease (Adachi et al, 1994; Nagy, 2003; Nanji et al, 2002; Thurman 1998).…”