Table 2.

Comparison of Russian Guidelines with other regional guidelines.

CLD phenotype	AASLD guidelines	EASL guidelines	APASL guidelines	Russian guidelines
ALD	The AUDIT and CAGE questionnaires are used along with alcohol biomarkers to aid in diagnosis. Relapse prevention medicines (naltrexone, acamprosate); cognitive-behavior therapy; and psychosocial therapy is recommended. Other treatment modalities are used in different forms of ALD, like alcoholic hepatitis, alcohol-associated steatosis. Liver transplant is undertaken is patients with decompensated alcohol-associated cirrhosis [10].	AUDIT questionnaire, MCV, AST/ALT, body mass index, LFT, non-invasive serum fibrosis test, and liver biopsy were used for diagnosis. Treatment modalities of different alcohol-associated liver disorder (alcoholic hepatitis, alcohol-associated fibrosis, alcoholic steatosis, alcoholic cirrhosis) have been elaborated in detail [12].	Various questionnaires are used to determine alcohol dependency, such as CAGE, MAST, and AUDIT. ALT, AST, AST/ALT, physical examination, hepatic imaging, and liver biopsy are used to establish the ALD diagnosis. Alcohol abstinence, naltrexone, or acamprosate in those who achieve abstinence, and nutritional therapy are recommended in ALD, while a separate treatment algorithm is followed for alcoholic hepatitis. Liver transplant in used in cirrhosis [89].	Ultrasound, TE, non-invasive fibrotests, direct laboratory markers (PEth, EtG, EtS, FAEE), and indirect markers (MCV, AST, AST/ALT, GGTP etc.) are used for diagnosis. Medicinal treatment for different ALD forms (alcoholic hepatitis), liver transplant, and rehabilitation is recommended. Additionally, silymarin is advised for use in ALD owing to its property to suppress lipid peroxidation [8].
NAFLD	Non-invasive assessment (NFS, FIB-4, EFL, serum biomarkers), imaging (vibration-controlled TE), and liver biopsy are used for diagnosis. Lifestyle intervention, insulin sensitisers, thiazolidinediones, vitamin E, bariatric surgery, and liver transplant are recommended [27].	Liver biopsy, ultrasound, biomarkers, scores of fibrosis, and HOMA-IR are used to diagnose NAFLD and associated metabolic syndrome. Diet and lifestyle modification, insulin sensitisers, antioxidants, cytoprotective, lipid-lowering agents, bariatric surgery, and liver transplant are recommended based on patient condition [26].	–	Imaging techniques; non-invasive diagnostic tests (Fibrotest, NAFLD fibrosis score, TE); and diagnostic liver biopsy are used as diagnostic aids. Metformin, pioglitazone, lipid-lowering agents, vitamin E, phospholipids, and UDCA along with other agents can be used as pharmacological treatment modalities. Silymarin use is also recommended [5].
DILI	Causality assessment and liver biopsy are conducted for diagnostic purposes. Discontinuation of the implicated agent, short-term administration of a bile acid resin, carnitine, N-acetylcystein, corticosteroids, along with other specific therapies according to causative agents, are used as treatment modalities [90].	Antibodies and HLA type tests are used for diagnosis of DILI and distinguish DILI and AIH. Injury from different drug categories had a different diagnostic approach. Liver biochemistry, imaging, and biopsy are recommended. Discontinuation of suspected agent and different targeted therapy for different agents are used (cholestyramine, carnitine, N-acetylcystein, UDCA, liver transplant) [29].	Laboratory testing, imaging, and biopsy are used for diagnosis. CDS and RUCAM scores are also employed. Withdrawal of suspected agent along with specific therapies (steroids, cholestyramine, carnitine, UDCA) is used as a management approach [91].	RUCAM scale is recommended for assessing risk of medication in DILI. Physical examination, laboratory and instrumental diagnostic techniques are used. Suspension of the causative agent is the primary step in the management of DILI. Medicinal agents (N-acetylcystein, L-carnitine, glycyrrhizic acid, L-ornithine L-aspartate, UDCA, ademetionine, glucocorticoids, phospholids) are used on a case-to-case basis [9].

ALD: Alcoholic liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AUDIT: Alcohol use disorders identification test; CDS: Clinical Diagnostic Scale; DILI: Drug induced liver injury; EFL: Enhanced Liver Fibrosis; EtG: Ethyl glucuronide; EtS: Ethyl sulphate; FAEE: Fatty acid ethyl esters; FIB-4: Fibrosis-4 index; GGTP: γ-Glutamyl transpeptidase; HLA: human leukocyte antigen; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; LFT: Liver function test; MAFLD: Metabolic-associated fatty liver disease; MAST: Michigan Alcohol Screening Test; MCV: mean corpuscular volume; NAFLD: Non-alcoholic fatty liver disease; NFS: NAFLD liver fat score; PEth: Phosphatidylethanol; RUCAM: Roussel-Uclaf Causality Assessment Method; TE: Transient elastography; UDCA: Ursodeoxycholic acid.