Ultrasound Helps Identify Alcohol-Induced Liver Disease

Researchers at the Autonomous University of Barcelona (UAB; Spain) and the Municipal Centre for Substance Abuse Treatment (Badalona, Spain) conducted a cross-sectional analysis of 301 AUD detoxification patients (80% male, median age 46 years), analyzing abdominal US scans in order to identify steatosis (fatty liver), hepatomegaly (liver enlargement), heterogeneous liver, and portal hypertension. Analytical liver injury was defined as aspartate aminotransferase (AST) levels between 74 and 300 units per liter (U/L), AST/alanine aminotransferase ratio of greater than 2, and total bilirubin of more than 1.2 milligrams per deciliter (mg/dL).

Among the patient cohort, prevalence of the hepatitis C virus was 21.2%, AST levels were 42 U/L, and ALT levels were 35 U/L (indicating liver enlargement or mild to moderate fatty liver disease); 16% of patients had analytical liver injury (ALI) and 24% had advanced liver fibrosis (ALF). US findings revealed that 57.2% had steatosis, 49.5% suffered from hepatomegaly, 17% had a heterogeneous liver, and 16% had portal hypertension. Of these, 77% had at least one US abnormality, and 45% had two or more. The study was published on July 19, 2018, in Drug and Alcohol Dependence.

“Liver damage is a major driver of disease burden in patients with unhealthy alcohol use, and liver disease is often diagnosed in advanced stages. Liver ultrasound appears to capture a significant proportion of mild to moderate abnormalities in patients who do not meet ALI or ALF criteria,” said lead author Daniel Fuster, MD, of UAB. “In this regard, the use of ultrasound to detect early stages of liver disease may promote alcohol cessation.”

Liver disease due to alcohol use can manifest in a variety of conditions, including acute alcoholic hepatitis, steatosis, steatohepatitis, cirrhosis of the liver, and hepatocarcinoma. Some of these can be reversed or mitigated if the patient quits drinking. For example, steatosis without inflammation can be reversed if drinking is stopped. Once steatohepatitis has been established, liver damage can't be fully reversed, but quitting alcohol can lessen portal hypertension. Alcoholic patients also tend to be more vulnerable to hepatitis C.

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Autonomous University of Barcelona