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Diagnostic Approaches and Clinical End Points of Treatment in Alcoholic Liver Disease

  • Chapter
Alcoholic and Non-Alcoholic Fatty Liver Disease

Abstract

The clinical types of alcoholic liver disease (ALD) are quite heterogeneous, ranging from early asymptomatic forms to life-threatening conditions such as alcoholic hepatitis (AH). Diagnosis of early-stage ALD is based on the combination of clinical, laboratory, and imaging findings. In these patients, the degree of liver fibrosis can be estimated by noninvasive tools. The diagnosis of AH is mainly based on clinical and analytical grounds, but in some cases, a definitive diagnosis requires a liver biopsy. The clinical end points of therapy in patients with ALD depend on the baseline condition. In patients with early asymptomatic phenotypes (fatty liver and steatohepatitis with or without fibrosis), the end points consist of normalization of laboratory abnormalities and resolution of fibrosis. In contrast, patients with severe forms such as decompensated cirrhosis and/or AH often have severe complications leading to early mortality. Therefore, the main clinical end point in these patients is short-term survival. Other important end points are the reduction in the occurrence and severity of clinical complications (i.e., acute kidney injury and sepsis) and the improvement of tests indicative of liver failure (i.e., MELD score). In this chapter, we describe the phenotypes, natural history, and diagnostic approaches as well as the clinical end points of patients with ALD.

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Abbreviations

ABIC:

Age, bilirubin, international normalized ratio, and creatinine

AH:

Alcoholic hepatitis

AHHS:

Alcoholic hepatitis histological score

ALD:

Alcoholic liver disease

ASH:

Alcoholic steatohepatitis

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

AUDIT:

Alcohol Use Disorder Inventory Test

CAP :

Controlled attenuation parameter

CDT:

Carbohydrate-deficient transferrin

CT:

Computed tomography

DF:

Discriminant function

GGT:

γ-Glutamyl-transpeptidase

HCC:

Hepatocellular carcinoma

HSC:

Hepatic stellate cells

INR:

International normalized ratio

MELD:

Model for End-Stage Liver Disease

MARS:

Molecular adsorbent recirculating system

MRI:

Magnetic resonance imaging

NASH:

Nonalcoholic steatohepatitis

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Authors and Affiliations

  1. Department of Gastroenterology, Ajou University of School of Medicine, Suwon, Republic of Korea

    Jaeyoun Cheong M.D

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 7340-A Medical, 111 Mason Farm Road, Chapel Hill, NC, USA

    Jaeyoun Cheong M.D, Eva Stein B.S & Ramon Bataller M.D., Ph.D.

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  2. Eva Stein B.S
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  3. Ramon Bataller M.D., Ph.D.
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Correspondence to Ramon Bataller M.D., Ph.D. .

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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Naga Chalasani

  2. Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

    Gyongyi Szabo

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Cheong, J., Stein, E., Bataller, R. (2016). Diagnostic Approaches and Clinical End Points of Treatment in Alcoholic Liver Disease. In: Chalasani, N., Szabo, G. (eds) Alcoholic and Non-Alcoholic Fatty Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-20538-0_10

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