Alcohol-related Liver Disease Top 10

  1. What are the most effective ways to help people with alcohol-related liver disease stop drinking?
  2. What are the most effective ways of delivering healthcare education and information about excessive alcohol consumption, the warning signs and the risks of alcohol-related liver disease to different demographics (including young people)?
  3. What is the most effective model of community-based care for patients with alcohol-related liver disease?
  4. What is the patient's experience of alcohol-related liver disease?
  5. Do attitudes to perceived 'self-induced illness' amongst healthcare professionals affect treatment, care provision and compassion for individuals with alcohol-related liver disease?
  6. What are the most effective strategies to reduce the risk of alcohol-related liver disease in heavy drinkers?
  7. Does the stigma associated with alcohol misuse affect the willingness of people with alcohol-related liver disease to ask for help?
  8. What interventions improve survival in individuals with complications of advanced alcohol-related cirrhosis?
  9. How should depression be managed in the context of alcohol-related liver disease?
  10. What models of involvement of palliative care services in advanced alcohol-related liver disease are most beneficial?

The following questions were also discussed and put in order of priority at the workshop:

  1. Are there any early signs of alcohol-related liver disease?
  2. What are the factors that determine who gets significant/advanced alcohol-related liver disease (affect progression)?
  3. What effect would greater alcohol-related liver disease education/training of GPs and secondary care clinicians have on the mortality outcome of alcohol-related liver disease patients?
  4. What is the relationship between alcohol-related liver disease and mental illness?
  5. What dietary recommendations or supplements (including herbal and vitamins) are beneficial in patients at risk of or with established alcohol-related liver disease?
  6. What effect does combining treatment of the liver disease with psychiatric support have on prognosis/mortality?
  7. What are the most effective messages and how are they best delivered in helping a patient with alcohol-related liver disease understand the condition and the importance of abstinence?
  8. Are there any effective treatments for alcohol-related liver disease apart from abstinence from alcohol?
  9. What are the obstacles for individuals to modification of their alcohol consumption?
  10. What lifestyle interventions improve outcomes in alcohol-related liver disease?
  11. What level and pattern of drinking behaviour affects the risk of getting alcohol-related liver disease (taking into account other risk factors for alcohol-related liver disease)?
  12. To what degree is established liver disease reversible?
  13. What are the most effective interventions delivered in combined clinics in the setting of secondary care for alcohol-related liver disease?
  14. What interventions improve survival in severe alcohol-related hepatitis?
  15. Is there a difference between the outcome of alcohol-related liver disease patients treated by specialised liver disease units/hepatologists versus general gastroenterologists?

The remaining uncertainties identified by patients, carers and health professionals who responded to the original survey were (in no order of priority):

  • Do specific interventions involving family members/social support improve maintenance of alcohol abstinence in individuals with alcohol-related liver disease?
  • Does the type of alcohol (e.g. wine, beer, spirits etc.) affect the risk, or progression, of alcohol-related liver disease?
  • Does the media portray excessive drinking in an inappropriately positive way and does this affect behaviour?
  • What is the impact on drinking behaviour of the ready availability of alcohol in social environments, at home and elsewhere?
  • Why is alcohol-related liver disease more prevalent in low socioeconomic groups?
  • What role do dietary factors have in susceptibility and prevention to alcohol-related liver disease?
  • What interventions best aid patients with alcohol-related liver disease maintain and manage employment?
  • What is the best screening test for alcohol-related liver disease and how should it be applied?
  • Should there be routine screening for alcohol-related liver disease?
  • Should screening for primary liver cancer in patients with alcohol-related liver disease be routinely performed?
  • What is the best method for diagnosing alcohol-related liver disease and where is this best done?
  • What are the needs and best methods for delivering support to care-givers both for themselves and the patient with alcohol-related liver disease?
  • What are the optimal ways of staging alcohol-related liver disease?
  • What medications for other conditions are the most effective and safe for use in patients with alcohol-related liver disease?
  • What are the best means of diagnosing hepatic encephalopathy (HE)/what is the role of new methods of diagnosing HE?
  • What factors in a person with alcohol-related liver disease indicate a favourable outcome following liver transplantation?
  • What treatments are safe and effective in treating alcohol withdrawal in patients with alcohol-related liver disease?
  • What are the appropriate quality markers for care in alcohol-related liver disease?
  • Which liver-assist machines can help survival to liver transplantation?
  • What is the best way of identifying which patients with severe alcohol-related liver disease needing intensive care support will survive?