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Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management

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Dr. Adrian Boicean

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Guest Editor

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
Interests: alcohol-related liver disease; E.R.C.P.; E.U.S.; gastric and colorectal cancer; pancreatic disease; fecal microbiota transplantation; inflammatory bowel disease; micro-RNA

Dr. Cristian Ichim

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Guest Editor

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
Interests: liver cirrhosis; fecal microbiota transplantation; E.R.C.P.; colorectal cancer; E.U.S.; micro-RNA; pancreatic cancer

Special Issue Information

Dear Colleagues,

Hepatic pathology remains a cornerstone in medical research, offering vast opportunities for innovation and discovery. Despite significant advancements recently, numerous critical questions remain, which require the concentrated efforts of the scientific community to answer. Alcoholic liver disease, probably the most widespread chronic liver condition globally, impacts a substantial patient population. Many individuals seek medical attention only when severe complications arise, which can lead to irreversible damage or even death. This places considerable strain on healthcare systems, underscoring the urgent need for accessible, cost-effective diagnostic tools and treatments capable of halting disease progression and promoting full recovery.

The effective management of liver disease yields extensive benefits, improving outcomes for patients, easing the burden on healthcare professionals and systems, and positively impacting society as a whole. These considerations highlight the need for thorough investigation and further research into the multifaceted challenges posed by alcohol-related liver disease.

We eagerly anticipate your valuable contributions and will facilitate meaningful dialogue that inspires transformative advancements in gastroenterology.

Dr. Adrian Boicean
Dr. Cristian Ichim
Guest Editors

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Research

16 pages, 2053 KB

Open AccessArticle

Chronic and Heavy Drinking, Nutrition Status, and Progression of Liver Injury Negatively Affect the Mortality Risk in Patients Suffering from Alcohol-Associated Hepatitis

by Aishwarya Thakurdesai, Anjali Kumari, Henry Shay, Khaled Elgharabawy, Evan J. Winrich, Wanyu Zhang, Amber Jackson, Matthew C. Cave, Maiying Kong, Xiang Zhang, Ashwani K. Singal, Craig J. McClain and Vatsalya Vatsalya

J. Clin. Med. 2025, 14(17), 6157; https://doi.org/10.3390/jcm14176157 - 31 Aug 2025

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Abstract

Background/Objectives: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. Methods: Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, n = 26, Gr.1) and severe (MELD ≥ 20, n = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71–9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child–Turcotte–Pugh, and Lille). Results: All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, p = 0.004), particularly in Gr.2 (r = 0.554, p = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R² = 0.539, p = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R² = 0.657, p = 0.017). Conclusions: Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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18 pages, 943 KB

Open AccessArticle

Fecal Microbiota Transplantation in Patients with Alcohol-Associated Cirrhosis: A Clinical Trial

by Cristian Ichim, Adrian Boicean, Samuel Bogdan Todor, Paula Anderco and Victoria Bîrluțiu

J. Clin. Med. 2025, 14(17), 5981; https://doi.org/10.3390/jcm14175981 - 24 Aug 2025

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Abstract

Background: Gut microbiota dysregulation is increasingly recognized as a key contributor to the progression of liver cirrhosis and its complications, particularly hepatic encephalopathy. Fecal microbiota transplantation (FMT) has emerged as a novel therapeutic strategy aimed at restoring intestinal microbial homeostasis and modulating systemic inflammation. Methods: This prospective, single-center clinical trial evaluated the short-term safety and efficacy of FMT in patients with alcohol-related liver cirrhosis. Clinical assessment, liver stiffness (via elastography), steatosis (controlled attenuation parameter), inflammatory biomarkers, and extended biochemical panels were analyzed at baseline, one week and one month post-FMT. A control group receiving standard medical therapy was used for comparison. Results: FMT was associated with a significant reduction in hepatic encephalopathy severity (p = 0.014), sustained improvements in liver stiffness (p = 0.027) and decreased steatosis (p = 0.025). At one month, C-reactive protein and neutrophil-to-lymphocyte ratio both declined significantly (p = 0.043), indicating a measurable anti-inflammatory effect. No serious adverse events were recorded. In comparison with controls, FMT recipients showed lower systemic inflammation and improved neuropsychiatric status. Conclusions: FMT demonstrated a favorable safety profile and yielded early clinical and biochemical benefits in patients with cirrhosis. These preliminary findings support the potential utility of microbiota-based interventions in chronic liver disease and warrant validation in larger, multicenter trials. Full article

(This article belongs to the Special Issue Alcohol-Related Liver Disease: Diagnosis, Treatment, and Management)

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