ACG Clinical Guideline 2024
Dr. Vijay Shah
Liver
Alcohol-Associated Liver Disease (ALD)
Disease spectrum, acute alcoholic hepatitis, treatment, and abstinence strategies — ACG 2024 Guidelines.
Disease Spectrum
ALD from steatosis to cirrhosis
Alcohol-Associated Liver Disease Spectrum
ALD represents a continuum from fatty liver to cirrhosis. Heavy alcohol use is defined as >14 drinks/week (women) or >21 drinks/week (men).
Steatosis
90%+ of heavy drinkers
Steatohepatitis
10–35% progress here
Fibrosis/Cirrhosis
10–20% of heavy drinkers
Acute Alcoholic Hepatitis
Severe, high mortality
Risk Factors for Progression
Amount and duration of alcohol consumption
Female sex (lower threshold for liver injury)
Genetic polymorphisms (PNPLA3, TM6SF2)
Obesity/metabolic syndrome (synergistic effect)
Concurrent HCV, HBV infection
Iron overload
Malnutrition
Laboratory Clues to ALD
AST:ALT ratio >2:1 (alcoholic hepatitis pattern)
MCV elevated (macrocytosis from alcohol)
GGT elevated disproportionately
CDT (carbohydrate-deficient transferrin) — alcohol biomarker
Low albumin, elevated INR in advanced disease
Thrombocytopenia (hypersplenism or alcohol toxicity)
Shah VH et al. ACG Clinical Guideline: Alcohol-Associated Liver Disease. Am J Gastroenterol. 2024.