Alcohol-associated liver disease.

Abstract

Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Western countries. The assessment of histological severity in ALD now relies predominantly on non-invasive methods, particularly elastography and blood-based tests, commercially available or laboratory-developed. These non-invasive approaches have largely replaced the need for liver biopsy. Management of ALD is based primarily on the treatment of alcohol use disorder, and access to pharmacological therapies and addiction specialists should be improved. At present, there is no specific treatment for ALD, with the exception of corticosteroid therapy for severe alcohol-associated hepatitis (AH), a distinct clinical entity associated with a poor prognosis that requires specialized management. In patients with advanced ALD who fail to improve despite sustained alcohol abstinence, liver transplantation remains the only effective therapeutic option. In this setting, a dedicated and multidisciplinary care pathway should be established to optimize patient selection, management, and long-term outcomes.