Diagnostic Approaches and Clinical End Points of Treatment in Alcoholic Liver Disease

The clinical types of alcoholic liver disease (ALD) are quite heterogeneous, ranging from early asymptomatic forms to life-threatening conditions such as alcoholic hepatitis (AH). Diagnosis of early-stage ALD is based on the combination of clinical, laboratory, and imaging findings. In these patients, the degree of liver fibrosis can be estimated by noninvasive tools. The diagnosis of AH is mainly based on clinical and analytical grounds, but in some cases, a definitive diagnosis requires a liver biopsy. The clinical end points of therapy in patients with ALD depend on the baseline condition. In patients with early asymptomatic phenotypes (fatty liver and steatohepatitis with or without fibrosis), the end points consist of normalization of laboratory abnormalities and resolution of fibrosis. In contrast, patients with severe forms such as decompensated cirrhosis and/or AH often have severe complications leading to early mortality. Therefore, the main clinical end point in these patients is short-term survival. Other important end points are the reduction in the occurrence and severity of clinical complications (i.e., acute kidney injury and sepsis) and the improvement of tests indicative of liver failure (i.e., MELD score). In this chapter, we describe the phenotypes, natural history, and diagnostic approaches as well as the clinical end points of patients with ALD.