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Alcohol use in patients with chronic liver disease

Boston Medical Center

A review article published in the New England Journal of Medicine discusses the effects of alcohol use on various forms of liver disease, as well as the assessment and treatment of alcohol use in patients with chronic liver disease.

Liver-related mortality is increasing worldwide, due in large part to the increase in alcohol consumption. This review is very timely, as recent epidemiological studies have shown that alcohol consumption that does not reach the risky range is associated with increased morbidity and mortality.

Below is a summary of the review article:

Alcohol use is common among patients with liver disease and is associated with poor outcomes. In addition, advanced liver disease can complicate the pharmacologic treatment of alcohol use disorder and alcohol withdrawal syndrome. In fact, medications approved for alcohol use disorder are prescribed to a minority of patients, yet they could be used by patients with chronic liver disease.

Given that there is no safe threshold for alcohol consumption and, if it exists, it is likely very low, abstinence should be encouraged in patients with chronic liver disease. In addition, liver transplantation could be considered for patients who abstain from alcohol and present with progressive liver failure.

The authors conclude that alcohol use disorder treatment should be expanded in everyday clinical practice to include patients with advanced liver disease.


This article was written by Daniel Fuster, MD, PhD, attending physician and associate professor of medicine at the Internal Medicine Service-Addiction Unit at Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona in Badalona (Spain) and Jeffrey H. Samet, MD, section chief of general internal medicine at Boston Medical Center and the John Noble MD Professor in General Internal Medicine at Boston University School of Medicine.

Reference: D. Fuster, J.H. Samet. Alcohol Use in Patients with Chronic Liver Disease. N Engl J Med. 2018: 379:1251-1261.

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