Diagnosis and Management of Early Stages of ALD

Jordi Gratacós-Ginès; Edilmar Alvarado-Tapias; David Martí-Aguado; Hugo López-Pelayo; Ramón Bataller; Elisa Pose

doi:10.1055/a-2541-2892

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2025; 45(02): 195-209
DOI: 10.1055/a-2541-2892

Review Article

Diagnosis and Management of Early Stages of ALD

Jordi Gratacós-Ginès

¹Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain

²Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

,

Edilmar Alvarado-Tapias

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

⁴Department of Gastroenterology and Hepatology, Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Barcelona, Spain

,

David Martí-Aguado

⁵Digestive Disease Department, Clínic University Hospital, Biomedical Research Institute INCLIVA, Valencia, Spain

,

Hugo López-Pelayo

²Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

⁶Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clínic de Barcelona, Barcelona, Spain

,

Ramón Bataller

¹Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain

²Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

,

Elisa Pose

¹Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain

²Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

› Author Affiliations

Abstract

Early forms of alcohol-associated liver disease (ALD) include different stages in the progression of compensated liver disease ranging from steatosis to steatohepatitis and fibrosis. ALD has been classically diagnosed at advanced stages more frequently than other liver diseases. This fact probably contributed to the scarcity of studies on early forms of ALD. Recent studies have investigated the prevalence of early ALD in the general population and have described the natural history of alcohol-induced steatosis and fibrosis, which have been linked to worse prognosis compared with early stages of other chronic liver diseases. In addition, studies on screening and early diagnosis of ALD in at-risk populations have shown that these strategies allow early detection and intervention. Of note, up to 28% of the United States population has concurrent alcohol use and metabolic syndrome, and estimated prevalence of advanced fibrosis among heavy drinkers with metabolic syndrome has increased from 3% in the 1990s to more than 10% in the 2010s. Therefore, new challenges and treatment opportunities will emerge for patients with ALD. In this review, we provide an overview of the state of the art in early ALD, focusing on natural history, diagnosis, and management, and provide insights into future perspectives.

Keywords

screening - fibrosis - steatosis - metabolic - alcohol

Full Text

References

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Supplementary Material