ACG guidelines advise on diagnosis, treatment of alcoholic liver disease

Patients with heavy alcohol use should be counseled that they are at increased risk for alcoholic liver disease, among other recommendations from the American College of Gastroenterology.


The American College of Gastroenterology (ACG) recently released guidelines to manage alcoholic liver disease, including concepts developed for specialists in liver disease, gastroenterologists, and primary care clinicians.

The concepts should be tailored to individual patients and circumstances in routine clinical practice, the guidelines state. They were published online by the American Journal of Gastroenterology on Jan. 16.

Recommendations include the following:

  • Patients with heavy alcohol use (more than three drinks per day in men and more than two drinks per day in women for more than five years) should be counseled that they are at increased risk for alcoholic liver disease (strong recommendation, low level of evidence).
  • Baclofen is effective in preventing alcohol relapse in patients with alcoholic liver disease (conditional recommendation, low level of evidence).
  • Brief motivational interventions are effective in reducing alcohol relapse versus no intervention in patients with alcoholic liver disease (conditional recommendation, very low level of evidence).
  • Patients with severe alcoholic hepatitis should be treated with corticosteroids if they are not contraindicated (strong recommendation, moderate level of evidence).
  • Available evidence does not support the use of pentoxifylline in patients with severe alcoholic hepatitis (conditional recommendation, low level of evidence).
  • Liver transplantation may be considered for highly selected patients with severe alcoholic hepatitis (strong recommendation, moderate level of evidence).

The guidelines also recommend that patients who have obesity or chronic hepatitis C virus infection should avoid alcohol and that patients who have alcoholic liver disease should not smoke cigarettes. Both are conditional recommendations based on a very low level of evidence.

In addition to recommendations, the guidelines also offered a list of key concepts and recommendations based on expert opinion and review of the literature, covering the disease spectrum of alcoholic liver disease, diagnosis of alcohol use disorder, management of alcoholic liver disease, diagnosis and treatment of alcoholic hepatitis, and liver transplantation in alcoholic liver disease.