Alcoholic Fatty Liver Disease (Alcoholic Liver Damage)

Alcoholic Fatty Liver Disease (Alcoholic Liver Damage) – Treatment Options

Introduction
Alcoholic fatty liver disease (AFLD) is the earliest and most common stage of alcohol-related liver disease, resulting from chronic excessive alcohol consumption. It is characterized by the accumulation of fat (steatosis) in hepatocytes. Most patients are asymptomatic, but some may present with fatigue, malaise, or right upper quadrant discomfort. While AFLD itself is reversible, continued drinking can progress to alcoholic hepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. The main goal of treatment is to reverse steatosis, prevent progression, and address the underlying alcohol use disorder.

---

1. Alcohol Abstinence (Core Therapy)

• Complete cessation of alcohol is the most important step.

• Fatty liver changes are often fully reversible within weeks to months of abstinence.

• Requires structured support: counseling, addiction treatment programs, relapse-prevention medications (naltrexone, acamprosate, disulfiram where appropriate).

---

2. Nutritional and Lifestyle Management

• Balanced diet: Adequate calories with high protein (1.2–1.5 g/kg/day) and nutrient-rich meals.

• Vitamin supplementation:

  • Thiamine (B1) to prevent Wernicke’s encephalopathy.

  • Folate, vitamin B12, vitamin D, and general multivitamin support.

• Weight management: Obesity accelerates liver damage; gradual weight loss helps reduce steatosis.

• Physical activity: Improves insulin sensitivity and reduces liver fat.

---

3. Pharmacological Support (Adjunctive)

• No specific drug reverses AFLD, but supportive agents are used:

  • Antioxidants (vitamin E, N-acetylcysteine): Limited evidence of benefit.

  • Pentoxifylline and silymarin: Studied in alcoholic liver disease but not standard of care.

• Medications for comorbidities: Control diabetes, hypertension, and dyslipidemia to reduce progression risk.

---

4. Monitoring and Surveillance

• Liver function tests (LFTs): AST, ALT, bilirubin, and GGT to track improvement after abstinence.

• Ultrasound or transient elastography (FibroScan): To assess steatosis and fibrosis risk.

• Regular follow-up: Early detection of progression to alcoholic hepatitis or cirrhosis.

---

5. Long-Term Support and Prevention of Progression

• Integration with addiction services: Behavioral therapy, support groups (AA), family counseling.

• Vaccinations: Hepatitis A and B immunization to prevent added liver injury.

• Education: Patients should be counseled about the risk of relapse and long-term liver complications.

• Screening for comorbidities: Diabetes, metabolic syndrome, and cardiovascular disease.

---

Prognosis

• Excellent if alcohol abstinence is achieved early, with complete reversal of fatty liver in most cases.

• Poor if drinking continues, as AFLD can progress silently to alcoholic hepatitis, cirrhosis, and liver failure.