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Alcohol-Related Liver Disease

NICE Clinical guideline [CG100] Alcohol-use disorders: diagnosis and management of physical complications. Last updated: Apr 2017.

Guidelines

Blood tests that suggest alcohol-related liver disease:

↑ AST and ALT
AST:ALT ratio >2
↑ GGT (associated with alcohol use)
Macrocytosis / macrocytic anaemia

Findings seen in impaired liver synthetic function
- ↑ Bilirubin
- ↑ PT / INR
- ↓ Albumin
- ↓ Platelet

Imaging:

1st line: ultrasound
- Hepatic steatosis (increased liver echogenicity)
- Hepatomegaly
- Heterogeneous echotexture (due to inflammation or fibrosis)
CT

Definitive: liver biopsy (but note that definite risks of morbidity and mortality are associated with liver biopsy)

Although NICE did not specify the diagnosis of alcohol-related liver disease, it can generally be diagnosed if there is 1) a significant history of alcohol intake, 2) clinical features of liver disease, and 3) characteristic blood test patterns.

Often supported by imaging findings. Whereas liver biopsy is reserved for uncertain cases or when precise staging is needed.

NICE recommends using transient elastrography (e.g. FibroScan) to check for cirrhosis in patients with alcohol-related liver disease.

See this article for further information on cirrhosis.

No specific treatment:

Alcohol abstinence and withdrawal (see this article)
Lifestyle advice (e.g. weight reduction, smoking cessation)
Assess nutritional requirements and offer support if needed
Optimise other comorbidities

Offer corticosteroid to severe alcoholic hepatitis with discriminant function ≥32

References

NICE guideline Alcohol-use disorders: diagnosis and management of physical complications

Background Information

Guidelines

References

Author: Adams Lau
Reviewer:
Last edited: 09/08/25

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