Gastroenterologist's Guide to Assess for Alcohol Use

Alcohol-associated liver disease (ALD) carries significant health care burden as it is the leading indication for hospitalization and liver transplantation among patients with chronic liver disease. Key challenge with ALD remains a delay in its diagnosis during the asymptomatic stage warranting the need for improved screening for heavy alcohol use. Further, given the impact of alcohol use in steatotic liver disease, accurate assessment of alcohol use is paramount. The aim of this study is to review the challenges associated with alcohol assessment, importance of subjective assessment, while reviewing available objective tools to assess for alcohol use.

We searched PubMed for studies evaluating the epidemiology of ALD, self-reporting tools and biomarkers available for assessing alcohol use across general population and chronic liver disease patients. Relevant articles and references were individually reviewed and included.

All patients should undergo screening for alcohol use with brief questionnaires. Detailed alcohol assessments should be completed in patients who screen positively on brief questionnaires. Patients undergoing evaluation for steatotic or chronic liver disease warrant a more thorough evaluation with inclusion of objective biomarkers to aid self-reporting questionnaires. Discordant findings between subjective and objective reports should be utilized as an opportunity to engage patients to discuss their alcohol use and review treatment plans to achieve sobriety.

Accurate alcohol use assessment requires a dual approach in which objective biomarkers are incorporated with self-reporting tools. Early diagnosis of harmful alcohol use accompanied with intervention and referral to treatment can help prevent downstream complications of ALD.