In this installment of our Guidelines Timelines Series, we will be conducting a comparative analysis of the American College of Gastroenterology’s (ACG) 2024 guideline on Alcohol-Associated Liver Disease in contrast to their previous 2018 version. Alcohol-associated liver disease (ALD) stands as a prominent cause of preventable liver-related morbidity and mortality on a global scale, including within the United States. The consumption of alcohol in a harmful manner poses a significant risk for liver damage and the development of ALD, often manifesting within the context of alcohol use disorder (AUD). This particular pattern of alcohol consumption is closely linked to adverse social and health outcomes.

While we will not delve into every aspect covered within these guidelines, we will highlight some key points. Without further delay, let us proceed!

Guidelines (2024 and 2018)
  • ACG Clinical Guideline: Alcohol-Associated Liver Disease

Major Changes & Key Takeaways: 2024 vs 2018
  • Terminology:
    • One significant difference between the 2024 guideline and its predecessor is the adoption of the term “Alcohol-Associated Liver Disease”. This term encompasses a wider range of alcohol-related liver conditions, such as alcoholic hepatitis and alcoholic cirrhosis. This reflects a more comprehensive approach compared to the 2018 version, which uses the term “Alcoholic Liver Disease.” The updated terminology in the 2024 guideline allows for a more nuanced understanding of the various liver conditions associated with alcohol consumption.
  • Diagnostic Criteria:
    • The 2024 guideline places a greater emphasis on utilizing alcohol biomarkers for diagnosis, whereas the 2018 guideline prioritizes clinical diagnosis and documenting heavy alcohol use.
    • Both guidelines stress the importance of ruling out other liver diseases, with the 2024 guideline specifically underscoring the significance of biomarkers in conjunction with patient self-report.
  • Management Strategies:
    • The 2024 guidelines underscore the importance of early intervention, multidisciplinary care, and screening for AUD. These guidelines also highlight advancements in pharmacotherapy, nutritional support, and the utilization of liver transplantation for eligible patients.
    • For individuals with ALD, it is recommended to implement integrated multidisciplinary care models that incorporate behavioral and/or pharmacotherapy for the treatment of AUD. The guidelines provide updated recommendations for the medical management of existing conditions and symptoms, as well as encourage collaboration with a multidisciplinary team of mental health experts for long-term care management.
    • In contrast, the 2018 guidelines prioritize prolonged abstinence as the most effective strategy, in addition to clinical management and personalized care. It is advised to counsel patients with heavy alcohol use about their heightened risk for developing alcoholic liver disease.
  • Alcohol-Associated Hepatitis (AH)
    • The 2024 guideline places a strong emphasis on the following key treatment strategies:
      • Corticosteroid Therapy: Recommended for patients with severe AH.
      • Adjuvant IV N-acetylcysteine: Used in combination with corticosteroids for severe AH.
      • Integrated Care Models: Highlights the importance of utilizing integrated multidisciplinary care models that incorporate behavioral and/or pharmacotherapy for the treatment of AUD in patients with ALD.
    • In contrast, the 2018 guideline focuses on the following aspects:
      • General Measures: Concentrates on inpatient management of liver disease complications, management of alcohol withdrawal syndrome, surveillance for infections, early effective antibiotic therapy, nutritional supplementation, and treatment of the underlying alcohol-use disorder.
      • Individualized Care: Recommends tailoring treatment approaches to individual patients and their unique circumstances in routine clinical practice.

Both guidelines stress the significance of effectively managing alcohol withdrawal syndrome and addressing the underlying alcohol-use disorder through a comprehensive, multidisciplinary approach to care.

These updates represent the latest advancements in our understanding of alcohol-related liver conditions, with the goal of enhancing patient care and outcomes. The 2024 guidelines offer a comprehensive strategy for managing ALD, with a focus on early intervention, multidisciplinary care, and innovative treatment options. Collaboration with a team of specialists and personalized care are key elements of these guidelines, guaranteeing the best possible results for patients with ALD.

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