Alcoholic Liver Disease

Publication Date: January 1, 2018
Last Updated: March 14, 2022


Environmental and genetic determinants

1. Patients with obesity or chronic HCV should avoid consumption of alcohol. (Conditional (weak)  “We suggest”, Very low)
2. Patients with ALD should be advised to abstain from cigarettes. (Conditional (weak)  “We suggest”, Very low)

Diagnosis of alcoholic use disorder

3. Patients who have heavy alcohol use (>3 drinks per day in men and >2 drinks in women) for >5 years) should be counseled that they are at increased risk for alcoholic liver disease. (Strong  “We recommend”, Low)

Management of alcoholic liver disease

Management of alcohol use disorder

4. In patients with ALD, baclofen is effective in preventing alcohol relapse. (Conditional (weak)  “We suggest”, Low)
5. In patients with ALD, brief motivational interventions are effective in reducing alcohol relapse compared with no intervention. (Conditional (weak)  “We suggest”, Very low)

Alcoholic hepatitis

Treatment of alcoholic hepatitis

6. Patients with AH should be considered for nutritional supplementation to ensure adequate caloric intake and to correct specific deficits, yet its effects on patient survival have not been proven. (Conditional (weak)  “We suggest”, Very low)
7. Patients with severe AH should be treated with corticosteroids if there are no contraindications for their use. (Strong  “We recommend”, Moderate)
8. The existing evidence does not support the use of pentoxifylline for patients with severe AH. (Conditional (weak)  “We suggest”, Low)

Liver transplantation in alcoholic liver disease

9. Liver transplantation may be considered for highly selected patients with severe AH. (Strong  “We recommend”, Moderate)

Recommendation Grading




Alcoholic Liver Disease

Authoring Organization

Publication Month/Year

January 1, 2018

Last Updated Month/Year

June 7, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

To develop this practice guideline document on the management of patients with ALD.

Target Patient Population

Patients with Alcohol Liver Disease

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D020751 - Alcohol-Induced Disorders, D019973 - Alcohol-Related Disorders, D005235 - Fatty Liver, Alcoholic, D008108 - Liver Diseases, Alcoholic, D005233 - Fatty Alcohols, D006519 - Hepatitis, Alcoholic


hepatitis, fatty liver, alcoholic liver disease

Source Citation

Singal, Ashwani K MD, MS, FACG; Bataller, Ramon MD, PhD, FACG; Ahn, Joseph MD, MS, FACG (GRADE Methodologist); Kamath, Patrick S MD; Shah, Vijay H MD, FACGACG Clinical Guideline: Alcoholic Liver Disease, American Journal of Gastroenterology: February 2018 - Volume 113 - Issue 2 - p 175-194 doi: 10.1038/ajg.2017.469

Supplemental Methodology Resources

Methodology Supplement