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.
- 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
- 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 AUDIT-C screening tool can be helpful in identifying patients who would benefit from further evaluation for alcohol use disorder
- Patients can self-monitor and decrease their alcohol consumption using a drinking diary/change plan wallet card
- When trying to help patients reduce their alcohol use, consider motivational interviewing and brief intervention
- Tools for reducing alcohol use in patients with hepatitis C apply to clinical care for all patients with chronic liver disease, regardless of etiology; these tools include the Brief Intervention Teaching Guide
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
ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol. 2018 Feb;113(2):175-194.
EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol. 2018 Jul;69(1):154-181.