What investigations are recommended for assessing the severity of liver disease in patients with a history of significant alcohol consumption?

For patients with a history of significant alcohol consumption, the recommended investigations to assess the severity of liver disease include a combination of clinical assessment, non-invasive imaging, blood tests, and sometimes liver biopsy. Transient elastography is advised to diagnose cirrhosis in men drinking over 50 units per week and women drinking over 35 units per week for several months, as well as in those diagnosed with alcohol-related liver disease. This non-invasive test helps assess liver stiffness, indicating fibrosis or cirrhosis ¹.

Routine liver blood tests alone should not be used to rule out cirrhosis, but they remain important to identify abnormal liver function and exclude alternative causes of liver disease ¹,². In cases of suspected acute alcohol-related hepatitis, the Maddrey's discriminant function (DF) is used to assess severity and guide treatment decisions; a DF score of 32 or more indicates severe disease and consideration for corticosteroid therapy after managing infections and renal impairment ².

If transient elastography is unsuitable or inconclusive, liver biopsy may be considered to confirm diagnosis and assess severity, especially in severe alcohol-related hepatitis requiring corticosteroid treatment ¹,². Referral to a hepatology specialist is recommended for confirmed cirrhosis or advanced liver disease ¹,².

Recent literature suggests that adjunctive therapies such as Lactobacillus GG may have beneficial effects on liver function and drinking behavior in moderate alcohol-associated hepatitis, indicating a potential role for microbiome-targeted interventions alongside standard assessments, though this does not replace established diagnostic investigations (Vatsalya et al., 2023).