Alcohol-associated liver disease (ALD) represents a spectrum of liver injury resulting from alcohol use, ranging from hepatic steatosis to more advanced forms including alcoholic hepatitis (AH), alcohol-associated cirrhosis (AC), and acute AH presenting as acute-onchronic liver failure. ALD is a major cause of liver disease worldwide, both on its own and as a co-factor in the progression of chronic viral hepatitis, nonalcoholic fatty liver disease (NAFLD), iron overload, and other liver diseases. ALD develops through several stages, beginning with hepatic steatosis, and, in some individuals, gradually progressing through AH (the histological correlate of which is alcoholic steatohepatitis), culminating in cirrhosis (Fig. 1).(1, 2) Progression through these various stages is dependent on continued heavy alcohol use and other risk factors, including female sex, genetic susceptibility, diet, and comorbid liver disease. ALD carries a significant stigma in society. It is increasingly recognized by providers that patients and their families seek to reduce the stigma of ALD, and a change from the term “alcoholic” to “alcohol-associated” will help; thus, alcohol-associated liver disease, alcohol-associated steatohepatitis, and alcohol-associated cirrhosis are suggested, retaining the familiar abbreviations (ALD, ASH, and AC, respectively). Due to longstanding usage, the term “alcoholic hepatitis” will likely persist. This 2019 ALD Guidance provides a data-supported approach to the prevalence, clinical spectrum, diagnosis, and clinical management of ALD and alcohol use disorders (AUDs). The Guidance was developed by consensus of an expert panel and provides guidance statements based on formal review and analysis of published literature on the topics. The quality (level) of the evidence and the strength of each guidance statement are not formally rated. Updates to the 2010 Guideline include an emphasis on AUD definition, screening, and treatment; new alcohol biomarkers; additional genetic and environmental susceptibility factors; a consensus

Abbreviations: ABIC, age, serum bilirubin, international normalized ratio, and serum creatinine; AC, alcoholic cirrhosis; AH, alcoholic hepatitis; AKI, acute kidney injury; ALD, alcoholic liver disease; AUD, alcohol use disorder; AUDIT, Alcohol Use Disorders Inventory Test; AUROC, area under the receiver operating characteristics curve; BMI, body mass index; CDT, carbohydrate-deficient transferrin; CI, confidence interval; CPT, Child-Pugh-Turcotte; EtG, ethyl glucuronide; EtS, ethyl sulfate; FDA, Food and Drug Administration; GAHS, Glasgow Alcoholic Hepatitis Score; G-CSF, granulocyte-colony stimulating factor; GGT, gamma-glutamyl transferase; GIB, gastrointestinal bleeding; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; LT, liver transplantation; MDF, Maddrey discriminant function; MELD, Model for End-Stage Liver Disease; MRI, magnetic resonance imaging; NAC, N-acetylcysteine; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NIAAA, National Institute on Alcohol Abuse and Alcoholism; PEth, phosphatidylethanol; RCT, randomized controlled trial; SIRS, systemic inflammatory response syndrome; STOPAH, Steroids or Pentoxifylline for Alcoholic Hepatitis; UNOS, United Network for Organ Sharing.