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Cited by 720Alcohol Consumption and Health EffectsLiver Disease and TransplantationSubstance Abuse Treatment and Outcomes

EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease

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European Association for the Study of the Liver·2012·Journal of Hepatology
DOI 10.1016/j.jhep.2012.04.004
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Abstract

Alcoholic liver disease (ALD) is the most prevalent cause of advanced liver disease in Europe. However, there has been limited research investment into ALD despite its significant burden on the health of Europeans. This disparity is reflected by the ETOh score – the ratio of the estimated population mortality rate to the number of trials focused on a particular disease. The ETOh score for ALD is 358, compared with 1.4 for hepatitis B, 4.9 for hepatitis C, and 15.2 for primary biliary cirrhosis. In recent years however, the mechanisms driving disease progression and the natural history of ALD have been better defined and novel targets for therapy have been identified. In addition, significant clinical research has produced a clear framework for the evaluation of new therapies in particular in patients with alcoholic steatohepatitis (ASH). ALD is a complex disease, the successful management of which hinges on the integration of all the competences in public health, epidemiology, addiction behavior and alcohol-induced organ injury. Both primary intervention to reduce alcohol abuse and secondary intervention to prevent alcohol-associated morbidity and mortality rely on the coordinated action of multidisciplinary teams established at local, national, and international levels. These guidelines are largely based on the issues raised during the EASL monothematic conference on ALD held in Athens in 2010. The guidelines have three main aims: (1) to provide physicians with clinical recommendations; (2) to emphasize the fact that alcohol can cause several liver diseases (steatosis, steatohepatitis, cirrhosis), all of which may coexist in the same patient; (3) to identify areas of interest for future research, including clinical trials. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. The strength of recommendations thus reflects the quality of underlying evidence. The principles of the GRADE system have been enunciated. The quality of the evidence in these clinical practical guidelines (CPGs) has been classified into one of three levels: high (A), moderate (B) or low (C). The GRADE system offers two grades of recommendation: strong (1) or weak (2) (Table 1). The CPGs thus consider the quality of evidence: the higher the quality of evidence, the more likely a strong recommendation is warranted; the greater the variability in values and preferences, or the greater the uncertainty, the more likely a weaker recommendation is warranted.

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  • Although hepatic steatosis does not normally cause irreversible hepatic changes, persistence and severity of alcoholic hepatitis or steatohepatitis leads eventually to fibrosis and sclerotic changes in the liver that result in liver cirrhosis and subsequent liver failure.

    “Although hepatic steatosis does not normally cause irreversible hepatic changes, persistence and severity of alcoholic hepatitis or steatohepatitis leads eventually to fibrosis and sclerotic changes in the liver that result in insidious replacement of hepatocytes with connective tissue (liver cirrhosis) and subsequent liver failure.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [278]

  • Alcohol use can also cause an inflammatory response known as alcoholic hepatitis, or steatohepatitis if it is accompanied by hepatic lipid deposition.

    “Alcohol use can also cause an inflammatory response known as alcoholic hepatitis, or steatohepatitis if it is accompanied by hepatic lipid deposition.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [278]

  • Alcohol use, especially heavy drinking occasions, induces changes in lipid metabolism resulting in the accumulation of lipids in hepatocytes called fatty liver.

    “Alcohol use, especially heavy drinking occasions, induces changes in lipid metabolism (increases lipogenesis and mobilization of lipids and simultaneously decreases hepatic lipid catabolism), resulting in the accumulation of lipids in hepatocytes called fatty liver.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [278]

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Authors
European Association for the Study of the Liver
Affiliations
Aarhus University (DK)
Corresponding author
European Association for the Study of the Liver
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2012-08
Volume
57
Issue
2
Pages
399-420
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2012.04.004
OpenAlex
W2153359097
Cited by
720
References
267
Citations by year
2026: 13 · 2025: 20 · 2024: 28 · 2023: 30 · 2022: 40 · 2021: 45 · 2020: 44 · 2019: 70 · 2018: 88 · 2017: 76 · 2016: 85 · 2015: 78 · 2014: 57 · 2013: 42 · 2012: 4
FWCI
41.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
alcoholic liver disease, alcoholic steatohepatitis, liver cirrhosis, alcohol-induced liver injury, alcohol consumption reduction, alcohol-related morbidity and mortality, multidisciplinary care, disease progression, natural history (disease), therapeutic target, clinical trial design, GRADE evidence grading
MeSH terms
Alcohol Drinking, Alcoholism, Europe, Gastroenterology, Humans, Liver Diseases, Alcoholic, Public Health, Societies, Scientific, Substance Withdrawal Syndrome, Liver Transplantation, Cost of Illness

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