Clinical Liver Disease

Read the new CLD Special Issue on Surgery of the Liver. Editor-in-Chief Michael Lucey, M.D. brings together a variety of articles on topics related to liver surgery, including the role of bariatric surgery in the management of NAFLD, laparoscopic liver resection, and infection after organ transplantation.

Click here to read more about liver surgery.

Read more from the current issue, addressing Alcoholic Liver Disease

Natural History and Factors Influencing the Course of Alcohol-Related Liver Disease
Stuart Kendrick, M.D., Ph.D., MRCP, Chris Day, M.D., Ph.D., FRCP, FAcMedSci

Alcohol-related liver disease is precipitated by alcohol consumption, but its clinical course is significantly influenced environmental, genetic, and behavioral factors. Drs. Kendrick and Day review the known environmental risk factors for ALD and how they can inform clinical strategies to slow disease progression.

Alcoholic Hepatitis: Diagnosis and Prognosis
Mary C. Drinane, Vijay H. Shah

Mortality rates for severe alcoholic hepatitis can be as high as 65%, making accurate diagnosis and assessment key to deciding which patients should receive supportive care versus aggressive treatment. Drs. Drinane and Shah compare the various severity scoring systems which can be used to determine the prognosis of patients with AH.

Treatment of Alcoholic Hepatitis
Timothy R. Morgan, M.D., Daniel Chao, M.D, and Gregory Botwin, M.D.

Current therapeutic strategies for alcoholic hepatitis involve a combination of alcohol abstinence, nutritional management, and drug therapy. Options for non-responders to these approaches remain uncertain, but liver transplantation and antioxidant drug treatment have shown encouraging results in clinical trials. Drs. Morgan, Chao and Botwin discuss.

Management of Extrahepatic Manifestations in Alcoholic Liver Disease
Joaquim Fernández-Solá, M.D., Ph.D.

ALD is just one of more than 60 alcohol-related diseases identified by the World Health Organization. Excessive alcohol consumption can also cause damage to the digestive tract, nervous, and vascular systems. Dr. Fernández-Solá reviews ethanol’s potential for systemic damage throughout the body, and lays out objectives for treatment of extrahepatic end-organ injury in patients with ALD.

Recent Trends in the Epidemiology of Alcoholic Liver Disease
Ashwani K. Singal, M.D., M.S., Bhupinderjit S. Anand, M.D., Ph.D.

After smoking and hypertension, alcohol ranks as the third most common preventable cause of death. Liver-related mortality from alcohol contributes to 4% of mortality globally, yet the amount of research into more effective treatment options for ALD is low compared to other types of liver disease. Watch, read, or listen to Drs. Singal and Anand discuss what is being done to address this important public health problem.

Access CLD on the go.
Listen to the author interviews and readings of the full articles by subscribing to the iTunes podcast.

Ramón Bataller, M.D.
UNC Gillings School of
Global Public Health
Chapel Hill, North Carolina

This issue of Clinical Liver Disease (CLD) explores the factors leading to alcoholic liver disease (ALD), as well as diagnosis, treatment, and management. Guest editor Dr. Ramón Bataller brings together an international team of experts to provide insight into caring for patients with alcoholic liver disease.

Test your knowledge!
Access the CLD Alcoholic Liver Disease Practice Question Bank to complete board-style practice questions and determine which articles and videos in this issue of CLD will be most useful to you.

Noninvasive Assessment of Patients with Alcoholic Liver Disease
Sebastian Mueller, M.D., Ph.D.

While liver biopsy remains important for ALD diagnosis, a variety of noninvasive techniques also play a key diagnostic role. Read Dr. Sebastian Mueller on how clinical findings, blood tests, biomarkers and more can inform ALD treatment decisions.

Management of Patients with Moderate Alcoholic Liver Disease
Neil Edward Crittenden, Craig McClain

Drs. Crittenden and McClain explore how to manage patients who have recovered from severe alcoholic hepatitis, have early signs of ALD, or early compensated cirrhosis. Read, listen, or watch to learn how lifestyle modification, nutrition management, and medical therapy can be combined to treat patients with moderate ALD.

Identification and Management of Alcohol Dependence and Withdrawal in Alcoholic Liver Disease
Jody B. Glance, M.D. and Andrea DiMartini, M.D

Providers treating patients with ALD are often focused on managing a medical crises rather than the psychosocial context in which it occurred, but Drs. Glance and DiMartini explain why it’s important not to lose sight of the big picture. Brief questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT), testing for biomarkers, and being vigilant for signs of alcohol withdrawal can all help identify patients who may benefit from a treatment referral for alcohol dependence.

Alcohol Consumption as a Cofactor for Other Liver Diseases
Jose Altamirano and Javier Michelena

Mix alcohol with other chronic liver diseases and the results include accelerated hepatic fibrosis and cirrhosis, increased risk of liver cancer, and death. While the impact of alcohol consumption on chronic liver diseases varies, there is no “safe” amount. Drs. Altamirano and Michelena describe the synergistic injuries resulting from alcohol consumption in the setting of combined clinical liver disease.

Liver transplantation for alcoholic liver disease
Patrizia Burra, M.D., Ph.D. and Michael R. Lucey, M.D.

Alcoholic liver disease is one of the most common causes of cirrhosis, however liver transplantation for ALD patients is controversial, in part because alcoholics are perceived to bear some responsibility for their illness. Drs. Burra and Lucey discuss how to evaluate ALD patients for liver transplantation, and medical management of ALD transplant recipients.

Histopathology of Alcoholic Liver Disease
Neil D. Theise, M.D.

Alcoholic liver disease is characterized by three stages of histopathological changes: steatosis, steatohepatitis, and steatofibrosis. Dr. Theise describes each stage, how histological findings may change with patient abstinence, and how to distinguish ALD from NAFLD.