Cirrhosis and Alcohol - Viral Hepatitis and Liver Disease
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Cirrhosis and Alcohol

for Health Care Providers

Avoidance of Alcohol for Patients with Cirrhosis - Cirrhosis

Patients with cirrhosis, regardless of etiology, should not drink any alcohol at all.

Key concepts

  • Any form of chronic liver disease can lead to cirrhosis - including alcoholic liver disease, hepatitis C virus, hepatitis B virus, non-alcoholic fatty liver, and many more
  • For people with liver disease who have not developed cirrhosis, the use of alcohol accelerates liver injury (fibrosis) and is associated with an increased risk of developing cirrhosis
  • For people with cirrhosis of any etiology, drinking alcohol can cause alcoholic hepatitis, which can precipitate acute-on-chronic liver failure (multisystem organ failure with high mortality rate)
  • Cirrhotic patients with active alcohol use are usually not eligible for liver transplantation
  • There is no safe amount of alcohol that can be consumed by patients with cirrhosis

Key recommendations

  • Recommend complete abstinence in all patients with cirrhosis
  • Assess alcohol use in all patients with cirrhosis using a nonconfrontational approach
  • Discuss implications of active alcohol use in patients with cirrhosis: risk of liver decompensation and contraindication to liver transplantation

Use Clinical Tools to Help Reduce Alcohol Use in Patients with Cirrhosis

The Potential Benefits of Abstinence for Patients with Alcoholic Cirrhosis

  • Abstinence improves liver function in patients with alcoholic cirrhosis
  • In patients with alcoholic cirrhosis, continuous alcohol use increases the risk of further decompensation, but sustained abstinence can improve liver function
  • Abstinence is the most effective therapy to decrease the risk of further liver damage
  • Patients with decompensated alcoholic cirrhosis (ascites, encephalopathy, variceal bleeding) can return to a compensated status if they stop drinking

References

ACG Clinical Guideline: Alcoholic Liver DiseaseLink will take you outside the VA website.. Am J Gastroenterol. 2018 Feb;113(2):175-194.

EASL Clinical Practice Guidelines: Management of alcohol-related liver diseaseLink will take you outside the VA website. VA is not responsible for the content of the linked site.. J Hepatol. 2018 Jul;69(1):154-181.