Modern approaches to the diagnosis of alcoholic liver disease

Abstract

The article presents up-to-date information about diagnostic methods for one of the most common and socially significant hepatological diseases-alcoholic liver disease. The most frequent clinical manifestations of this pathology are asthenic, dyspeptic, right hypochondrium, cholestatic, neurological, edematous-ascitic and hemorrhagic syndromes. Validated questionnaires are intended for standardized alcohol use screening, the «gold standard» among which is the «AUDIT» questionnaire aimed at identifying alcohol use disorders. Most of the physical signs of chronic alcohol abuse are presented in the modified LeGo grid. Direct indicators (markers) of laboratory diagnosis of alcohol use include the determination of phosphatidyl ethanol and ethyl glucuronide in blood serum and urine; ethyl glucuronide and fatty acid ethyl esters in hair; ethanol, aminotransferase, peroxidase, ethylglucuronide, ethyl sulfate, haptoglobin, etc., in saliva. Indirect markers include macrocytic anemia, neutrophilic leukocytosis, increased activity of gamma-glutamyl transpeptidase, transaminases, de Ritis coefficient, bilirubin, alkaline phosphatase, serum immunoglobulin A and gamma globulins. Determination of carbohydrate-deficient transferrin is recommended as a preferred marker of alcohol intoxication. In order to determine the degree of fibrosis, predictive diagnostic serum tests are used, both non-proprietary («APRI», «Forns») and commercial («Fibrometer», «Hepascore», «Fibrospect» etc.). The methods of visual diagnostics of liver diseases include ultrasound, magnetic resonance and computed tomography, which can determine steatosis, exclude other causes of liver damage, reveal signs of severe fibrosis or cirrhosis, as well as their complications, but none of them allows to establish the etiology of the lesion. A promising direction is to determine the degree of steatosis when measuring the controlled parameter of ultrasound attenuation, implemented in the «Fibroscan» apparatus. The most accurate methods for diagnosing steatosis today are magnetic resonance imaging of the liver in the mode of determining the proportion of fat, weighted by proton density, and proton magnetic resonance spectroscopy. To determine the degree of fibrosis, a transient, two-dimensional shear wave and magnetic resonance elastography are used. Biopsy followed by morphological examination is the «gold standard» for the diagnosis of alcoholic liver disease, which confirms the presence of liver damage, establishes its stage and often allows confirming alcoholic genesis. However, this procedure has a number of significant drawbacks, so it is advisable to use non-invasive diagnostic techniques for screening, primary examination and further monitoring of the patient’s condition in dynamics. 

Keywords

alcoholic liver disease / diagnostics / alcohol used questionnaires / predictive serum tests / markers of alcohol consumption / liver fibrosis / liver steatosis / liver cirrhosis / liver biopsy / liver morphology / elastography

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RIGHTS & PERMISSIONS

Zhirkov I.I., Gordienko A.V., Yakovlev V.V., Serdyukov D.Y.