Table 1. Side-by-side comparison of the recommendations discussed in the AFEF, AASLD and EASL guideline for alcohol-related liver disease.
| Recommendations | AFEF (1) | AASLD (2) | EASL (3) |
|---|---|---|---|
| Detecting excessive alcohol consumption | |||
| AUD screening | |||
| General population (AUDIT-C) | Yesa | Yes | Yes |
| Cognitive impairment? | Yes | –b | Yes |
| Other addictions (e.g., smoking) | Yes | – | Yes |
| Brief intervention recommended? | |||
| Psychosocial/behavioral? | Yes | Yes | Yes |
| Pharmacological intervention? | Yes | Yes | Yes |
| Biomarkers of alcohol consumption? | |||
| General population | Noc | Yes | – |
| Specialist referral | Possibled | Yes | Possible |
| Before/after liver transplant? | – | Yes | Yes |
| Consumption profile | |||
| Screen for binge drinking | Yes | – | – |
| Educate on risks of binge drinking? | Yes | – | – |
| Research on binge drinking? | Yes | – | – |
| Harm reduction | |||
| Definition of standard drink (grams) | 10 | 14 | 10 |
| Definition of binge drinking | |||
| Within 2 h (drinks) | – | >4/5 (f/m) | >4/5 (f/m) |
| Within 24 h (grams) | >60 g | – | >60 g |
| Definition of daily safe drinking (ALD) | |||
| Daily (drinks) | <2 | <1/2 (f/m) | <1 |
| Weekly (drinks) | <10 | – | – |
| Weekly alcohol-free day? | Yes | – | – |
| No drinking in ALD/cirrhosis? | Yes | Yes | Yes |
| Medical management of AUD: the influence of advanced liver disease | |||
| Treatment of alcohol withdrawal | |||
| Use of benzodiazepines? | Yes | – | Yes |
| Modify regimen/drug for liver disease? | Yes | – | Yes |
| Management of abstinence | |||
| Contraindications in liver disease? (e.g., disulfiram, naltrexone) | Yes | Yes | Yes |
| Safe drugs for liver disease? (e.g., acamprosate and baclofen) | Yes | Yes | Yes |
| Invasive and non-invasive diagnosis of fibrosis and steatosis in ALD | |||
| Medical semiology | – | Yes | Yes |
| Fibrosis assessment | |||
| Imaging (e.g., TE or MRI)? | Yes | Yes | Yes |
| Blood tests | Yes | Yes | Yes |
| Steatosis assessment | |||
| Imaging (e.g., CAP, MRI) | No | Yes | Yes |
| Liver biopsy in non-AH ALD | If needed for differential diagnosis and/or grading of disease severity | ||
| Alcohol-related liver disease and comorbidities | |||
| Screen/treat smoking? | Yes | – | Yes |
| Screen/treat psychiatric disorders? | Yes | – | Yes |
| Screen/treat obesity/metabolic syndrome? | Yes | Yes | Yes |
| Other coexistent liver disease? | – | Yes | – |
| Screening for ALD in the general population | |||
| Targeted screening? | Yes | – | Yes |
| Utility of imaging? | Yes | – | Yes |
| Utility of LFTs? | No | – | Yes |
| Utility of other blood tests? | Yes | – | Yes |
| AH | |||
| Biopsy to confirm AH? | If needed for differential diagnosis | ||
| NIAAA criteria in absence of biopsy? | Yes | Yes | Yes |
| Non-invasive tests for AH (e.g., CK 18) | Yes, but need more to improve diagnosis/prognosis | ||
| Utility of laboratory scores | |||
| Severity assessment | MDF and MELD preferred | ||
| Prognosis assessment | MELD and Lille preferred | ||
| Initiating corticosteroids | MDF (and GAHS) preferred | ||
| Cessation of corticosteroids | Lille preferred | ||
| Tissue-based scores (e.g., AHHS)? | – | Limited use | Limited use |
| Importance of infection screening | Yes | – | Yes |
| Treatment of AH | |||
| Abstinence | Yes | Yes | Yes |
| Nutrition | – | Yes | Yes |
| Corticosteroids | Yes | Yes | Yes |
| N-acetylcysteine | Possible | Possible | Possible |
| GC-SF | – | Possible | Possible |
| Pentoxifylline | No | No | No |
| Fast track liver transplant benefit? | Yes | Yes | Yes |
The order of comparison was based on the order of discussion and guidelines in the AFEF document (1). Some areas that were discussed in AASLD and/or EASL guidelines (e.g., management of alcohol-related cirrhosis) were not covered in the AFEF guidelines and therefore no comparison was made. a, “Yes” indicates that a specific guideline recommendation was made in favor; b, “–” indicates that no specific guideline recommendation was made, even if the topic was discussed; c, “No” indicates that a specific guideline recommendation was made against; d, “Possible” indicates that guidelines suggest recommendation, but with limited data to support. AFEF, French Association for the Study of the Liver; AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of Liver; AUD, alcohol use disorder; AUDIT, alcohol use disorder identification test; f/m, female/male; ALD, alcohol-related liver disease; TE, transient elastography; MRI, magnetic resonance imaging; CAP, controlled attenuation parameter; AH, alcohol-related hepatitis; LFTs, liver function tests; NIAAA, National Institute on Alcohol Abuse and Alcoholism; CK 18, cytokeratin 18; MDF, Maddrey’s discriminant function; MELD, model of end-stage liver disease; GAHS, Glasgow Alcoholic Hepatitis Score; AHHS, Alcoholic Hepatitis Histological Score; GC-SF, Granulocyte Colony Stimulating Factor.