Subclinical versus advanced forms of alcohol-related liver disease: Need for early detection

Alcohol-related liver disease (ALD) consists of a wide spectrum of clinical manifestations and pathological features, ranging from asymptomatic patients to decompensated cirrhosis and hepatocellular carcinoma. Patients with heavy alcohol intake and advanced fibrosis often develop a subacute form of liver failure called alcohol-induced hepatitis (AH). Globally, most patients with ALD are identified at late stages of the disease, limiting therapeutic interventions. Thus, there is a need for early detection of ALD patients, which is lacking in most countries. The identification of alcohol misuse is hampered by the existence of alcohol underreporting by many patients. There are useful biomarkers that can detect recent alcohol use. Moreover, there are several non-invasive techniques to assess the presence of advanced fibrosis among patients with alcohol misuse, which could identify patients at high risk of liver related events or early death. In this review, we discuss differences between early stages of ALD and AH as the cornerstone of advanced forms. A global overview of epidemiological, anthropometric, clinical, analytical, histological, and molecular differences is summarized in this article. We propose that campaigns aimed at identifying patients with subclinical forms can prevent the development of life-threatening forms. (Clin Mol Hepatol 2023;29:1-15)

Automated summary

Alcohol-related liver disease (ALD) encompasses a wide range of clinical presentations, from asymptomatic patients to severe complications like cirrhosis and cancer. Late-stage identification of ALD limits effective treatment options, highlighting the need for early detection, which is lacking in many countries. Alcohol underreporting by patients hampers the identification of alcohol misuse, but there are biomarkers and non-invasive techniques available to detect recent alcohol use and assess fibrosis severity. This article provides a comprehensive overview of the differences between early stages of ALD and alcohol-induced hepatitis (AH) and suggests campaigns targeting early identification of subclinical forms to prevent life-threatening complications. (Clin Mol Hepatol 2023;29:1-15)