Assessment of Pharmacological Interventions of Chronic Alcoholic Liver Disease and Their Clinical Outcomes

Abstract

This study aims to evaluate the effectiveness of pharmacological interventions for chronic ALD, analyze the demographic and clinical profile of ALD patients, assess the associated complications, and investigate the prescription patterns of drugs used in ALD treatment. Methods and materials: This prospective observational study was conducted in the outpatient and inpatient units of the Department of Gastroenterology at a tertiary care hospital. The study was carried out over a 6-month period, with a total sample size of 64 subjects. Results and discussion: The study focuses on 64 subjects with ALD, recommending nutritional support(76.6%), alcohol abstinence(95.3%), ursodeoxycholic acid(60.9%), antibiotics(42.2%), and benzodiazepines(25%) for management and prognosis. Liver transplant is the only viable treatment, with hepatologists and addiction specialists providing integrated therapy. Out of 16 alcoholic hepatitis patients, 56.3% improved, 43.8% had persistent conditions, and 83.3% improved in compensated disease state. Conclusion: The study found that alcohol abstinence, along with nutritional and pharmacological therapy, improves quality of life in compensated ALD. Liver transplantation is an option for advanced cases. Psychological and pharmacological support aid in abstinence, though alcohol withdrawal can cause behavioral, gastrointestinal, and neurological issues.

Introduction

I. Overview of Alcoholic Liver Disease (ALD)

• Cause & Progression: ALD is primarily caused by excessive alcohol consumption, and progresses through three stages:

  1. Alcoholic Fatty Liver – Fat accumulation in the liver; often asymptomatic.

  2. Alcoholic Hepatitis – Inflammatory damage; can be life-threatening.

  3. Cirrhosis – Irreversible liver scarring; may lead to complications like portal hypertension, liver failure, and hepatocellular carcinoma.

• Risk Factors: ALD risk increases with:

  • Heavy, long-term drinking

  • Gender (women are more susceptible)

  • Obesity, genetics, age, ethnicity

  • Poor diet, drug use, viral infections, smoking

• Symptoms:

  • Early: Fatigue, nausea, abdominal pain

  • Advanced: Jaundice, swelling (ascites), confusion (hepatic encephalopathy), weight loss

• Diagnosis Tools:

  • Screening: AUDIT, AUDIT-C

  • Physical exams, blood tests, imaging (CT, ultrasound), and sometimes liver biopsy

II. Rising Public Health Concern

• Over the past decade:

  • 30% rise in alcohol use disorders

  • 50% increase in high-risk drinking, particularly in younger women, older adults, and minority or low-income groups

  • 40% increase in ALD-related mortality

III. Treatment & Management

• Primary Treatment: Complete alcohol abstinence, which significantly improves outcomes.

• Supportive Treatments:

  • Nutritional therapy (vitamins, protein-rich diet)

  • Medications:

    • Benzodiazepines – for alcohol withdrawal

    • Antibiotics – for gut bacterial control

    • Antioxidants (e.g., NAC, SAMe)

    • Corticosteroids – for severe alcoholic hepatitis

    • Ursodeoxycholic acid, analgesics, albumin

  • Psychological support: CBT, MET, rehab programs

• Liver Transplantation: Considered for severe cases but requires sustained abstinence.

IV. Study Design and Methodology

• Study Type: 6-month prospective observational study

• Participants: 64 ALD patients (male & female, diabetic & non-diabetic)

  • Excluded: pregnant/lactating women, transplant recipients

• Statistical Tools: Chi-square tests, frequencies, percentages, P-values (<0.05 considered significant)

V. Key Findings from the Study

A. Diagnosis Distribution (n=64)

B. Social Habits

• 90.6% consumed alcohol only

• 9.4% consumed both alcohol and smoked

C. Treatment Given

D. Effect of Alcohol Abstinence

• P-value = 0.011 (Significant correlation between abstinence and improvement)

E. Disease State vs. Patient Condition

• P-value < 0.001 (Significant association between disease stage and patient outcome)

Conclusion

This prospective observational study included 64 adult patients with Alcoholic Liver Disease (ALD), encompassing both diabetic and non-diabetic individuals. The study aimed to assess the effectiveness of various screening tools, treatment approaches, and their impact on patient outcomes. We utilized standardized screening tools like the Alcohol Use Disorder Identification Test (AUDIT) and the CAGE questionnaire to evaluate alcohol consumption patterns and identify potential Alcohol Use Disorder (AUD). The treatment regimen primarily comprised nutritional support, alcohol abstinence, and pharmacological interventions like ursodeoxycholic acid, antibiotics, and benzodiazepines. A significant proportion of patients experienced alcohol withdrawal symptoms, including behavioral changes, gastrointestinal disturbances, and neurological manifestations. The study revealed that patients with compensated liver disease exhibited significant improvement with a combination of abstinence, nutritional therapy, and pharmacological interventions. However, for patients with advanced or decompensated liver disease, liver transplantation emerged as a viable therapeutic option.

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Copyright

Copyright © 2025 Dr. Sethu Babu, D. Pravalika, D. Amulya, T. Nitha, MS. JE Rachel Nivedita . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.