Outpatient follow-up of patients with alcohol-associated liver cirrhosis by a primary care physician. Guidelines

The guidelines describe the organization of follow-up of patients with alcohol-associated liver cirrhosis by a general practitioner.
This document presents modern approaches to diagnostics, including clinical and paraclinical methods necessary for follow-up monitoring of patients with alcohol-associated liver cirrhosis. It also includes treatment standards covering both pharmacological and non-pharmacological methods aimed at slowing the disease progression, preventing complications and improving the quality of life. Special emphasis is placed on the integration of a multidisciplinary approach, involving collaboration among specialists to optimize patient management. The guidelines are based on evidence-based medicine and include the latest clinical research and international standards, making them relevant and useful for practitioners.
The guidelines are intended for general practitioners, family doctors, as well as for mid-level health providers working with the above-mentioned doctors, for paramedics performing the doctor functions. The guidelines can be used by public health physicians, heads of primary health care facilities and their divisions.

1. Crabb DW, Im GY, Szabo G, et al. Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020; 71(1):306-33. doi:10.1002/hep.30866.

2. Loscalzo J, Fauci A, Kasper D, et al. Harrison’s Principles of Internal Medicine, 21e. McGraw-Hill Education. 2022. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095&sectionid=265394555. ISBN: 978-1-26-426851-1 2617-2619.

3. Sanyal A, Boyer T, Terrault N, et al. Zakim and Boyer’s hepatology: a textbook of liver disease, 7e; 2018. doi:10.1016/C2013-0-19055-1.

4. Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. Journal of Hepatology. 2018;69(1):154-81. doi:10.1016/j.jhep.2018.03.018.

5. Agarwal A, Taneja S, Chopra M, Duseja A, Dhiman RK. Animal Naming Test — a simple and accurate test for diagnosis of minimal hepatic encephalopathy and prediction of overt hepatic encephalopathy. Clin Exp Hepatol. 2020 Jun;6(2):116- 124. doi:10.5114/ceh.2019.95105. Epub 2020 May 8. PMID: 32728628; PMCID: PMC7380476.

6. Nikonov EL, Aksenov VA. Hepatic encephalopathy. Russian Journal of EvidenceBased Gastroenterology. 2017;6(4):25-31. (In Russ.) doi:10.17116/dokgastro20176425-31.

7. Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-Associated Liver Disease. The American Journal of Gastroenterology. 2024;119(1):30-54. doi:10.14309/ajg.0000000000002572.

8. Drapkina OM, Gorny BE, Kalinina AM, et al. Increasing motivation to stop drinking alcohol during preventive counseling in the provision of primary health care to women of childbearing age. Voronezh: Stationery LLC, 2019. 28 p. (In Russ.) ISBN: 978-5-6043603-7-8.

9. Gorny BE, Kalinina AM, Dolgova SV, et al. Organizational and functional technology of screening and preventive counseling of patients with harmful alcohol consumption and the results of its testing in primary healthcare. Preventive medicine. 2019;3:14-9. (In Russ.) doi:10.17116/profmed20192203114.

10. Kaner E, Beyer F, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018;2(2):CD004148. doi:10.1002/14651858.CD004148.pub4.

11. NIAAA (2005). Helping Patients Who Drink Too Much. A clinician’s guide. 2005, 40 p. https://www.drugsandalcohol.ie/20378/.

12. Raikhelson KL, Bueverov OA, Kondrashina EA, et al. Intrahepatic cholestasis in chronic liver diseases and the role of ademethionine in its treatment (literature review and resolution of the Council of Experts). Russian Journal of Gastroenterology, Hepatology, and Coloproctology. 2024;3(4):20-33. (In Russ.) doi:10.22416/1382-4376-2024-1167-309.

13. Belyakin SA, Pavlov AI, Shames AB, Frolkin MN. Alcohol consumption and mortality rates from cirrhosis of the liver — two interrelated factors. problems of medical rehabilitation and rehabilitation treatment. Hospital medicine: science and practice. 2021;4(1):54-58. (In Russ.) doi:10.34852/GM3CVKG.2021.93.29.008.