Management of ArLD

The essential part of successful management of ArLD is abstinence from alcohol. Fatty liver can be entirely reversible and other later presentations can be stabilised and improved with cessation of alcohol.

Corticosteroids are not a routine ED treatment for all patients. In selected severe alcohol-related hepatitis, steroids may provide a modest improvement in 28-day survival, but there is no sustained benefit at 90 days or 1 year, and treatment carries infection risk. Steroid use should therefore be specialist-led decision following infection screening and formal severity assessment. [11]

Nutritional support should also be given greater prominence, as malnutrition is common and clinically important in severe disease.

Studies have shown patients who had at least 2500 kcal per day had improvements in liver function and six month survival than those who had less. Enteral feeding maximises digestion and may improve long-term survival in ArLD patients. Interestingly, although obesity can be an independent risk factor for ArLD progression, weight loss has not been shown to be of benefit in alcoholic fatty liver disease and may actually worsen liver injury. [6]

Learning Bite

At all stages of ArLD abstinence is key to management.