This JAMA review covers the epidemiology, diagnosis, risk factors, and management of alcohol-related liver disease (ALD), including alcohol-associated hepatitis and cirrhosis, with emphasis on noninvasive fibrosis testing and alcohol cessation strategies.
Sustained alcohol abstinence in patients with alcohol-related cirrhosis was associated with significantly reduced liver-related mortality (aHR 0.43, 95% CI 0.26–0.70) and all-cause mortality (aHR 0.45, 95% CI 0.30–0.67) over a median 36-month follow-up. ALD-related mortality in the US nearly doubled from 6.7 to 12.5 deaths per 100,000 people between 1999 and 2022.
This is a narrative review, not a systematic review or meta-analysis, so findings reflect curated evidence rather than pooled analysis. Mortality statistics are population-level and may not capture subgroup heterogeneity. Alcohol consumption data rely partly on self-report, which is known to be underreported.
Screen patients with chronic daily heavy alcohol use (>20 g/day in women, >30 g/day in men) for ALD using noninvasive tools like Fibrosis-4 score and transient elastography. Prioritize alcohol cessation — with motivational therapy, CBT, or pharmacotherapy (baclofen, naltrexone) — and refer patients with severe alcohol-associated hepatitis or decompensated cirrhosis for liver transplant evaluation.
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