How to treat alcohol associated liver disease - Dr. Pathik Parikh

 



Treatment of alcohol related liver disease encompasses multiple steps. Just asking to stop alcohol is not enough. Here are the things which we need to look at while dealing with alcohol related liver disease


  1. Abstinence Counselling
  2. Alcohol withdrawal
  3. Alcohol Craving
  4. Alcohol associated fatty liver and hepatitis
  5. Fibrosis and Cirrhosis – Complication of cirrhosis
  6. Liver Transplant
  1. General Measures
  • Alcohol abstinence is the cornerstone of therapy
  • Early management of Alcohol dependence is recommended in all patients
  • Considering the potential risk of Wernicke’s encephalopathy supplementation with B-complex vitamins is recommended
  1. Behavioural Treatment
  • Cognitive behavioural Therapy
  • Motivational enhancement
  • Contingency management
  1. Nutritional Therapy
  • High protein diet – Do not restrict proteins
  • High calorie diet – Can eat routine home-made foods including roti, sabzi, dal and rice
  • Can have milk and milk products – add protein powder to it
  • Low salt diet – Avoid papad, pickles
  • All fruits and vegetables including coconut water
  • Multivitamin supplementation
  1. Alcohol Withdrawal
  • Chlordiazepoxide is preferred if patient do not have advanced liver disease
  • Lorazepam is preferred in advanced cirrhosis
  • Diazepam is avoided
  1. Alcohol Craving
  • Baclofen and acamprosate may be preferred
  • Disulfiram to be used only under supervision
  • Gabapentin, Ondansetron, Topiramate has off label use
  1. Alcoholic Hepatitis
  • Nutrition is the treatment of choice. All patients should get adequate nutrition. Do not restrict any foo
  • Steroids to be used in patients with severe alcoholic hepatitis
  • Pentoxyfylline, UDCA, Glutathione, Silymarin, Metadoxine, SAMe – all have non proven benefit
  • Hepatologist consultation is must as those patients who do not respond may need transplant
  1. Alcohol cirrhosis
  • These patients are treated as same way as any other cirrhosis
  • Need screening for varices and hepatocellular carcinoma
  1. Liver Transplant
  • Liver transplant should be considered in such patients when alcoholic hepatitis fails to respond to medical management
  • Liver transplant to be considered for cirrhosis of liver and its complications
  • Psychiatric fitness stating willingness to abstain is of paramount importance

The above is the management in brief about alcohol related liver disease. If you have any patient suffering from alcohol and associated liver problems, do consult your hepatologist. To know more, feel free to call 8652119730

More: www.drpathikparikh.com/

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