Alcohol‐related liver disease (ALD) is the most frequent end‐organ complication encountered among adults with prolonged heavy alcohol consumption. It accounts for more than a quarter of cirrhosis‐related deaths worldwide. Despite its ubiquity, the true incidence, prevalence, and natural history of ALD, including factors which modify the disease course, remain largely unknown. The majority of patients are diagnosed when they present to the healthcare service with advanced disease. ALD comprises a wide clinicopathological spectrum. Histologically, the disease ranges from isolated steatosis to alcohol‐related steatohepatitis (ASH) and progressive fibrosis. Advanced disease is associated with the development of liver failure, alcohol‐associated hepatitis (AH), cirrhosis, and their attendant complications, including portal hypertension and hepatocellular carcinoma (HCC). AH is characterized by recent onset and often profound jaundice with additional features of liver failure. Clinically patients display an intense systemic inflammatory response and may develop additional organ failure and consequent acute‐on‐chronic liver failure (ACLF). In its severe forms, AH carries a poor prognosis, with short‐term mortality reaching up to 50% at 3 months. Therapies other than supportive measures do not increase long‐term survival.

Alcohol consumption worldwide

The global annual per capita consumption of alcohol increased from 5.7 to 6.4 liters of pure ethanol over the period 2000–2016. The highest rate of consumption is in Europe (9.8 liters/person/year) (Figure 56.1

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