Preventing cirrhosis: Why primary care clinicians should screen for liver disease in patients who drink heavily

T he American College of Gastroenterology (ACG) 1 recommends screening individuals with heavy alcohol use for liver disease.Universal screening for alcohol use is most applicable in the primary care setting because it is where patients with heavy alcohol use and alcohol-related liver disease may be identifi ed before they develop advanced liver damage.Once these patients present to a gastroenterology clinic, their liver disease is often signifi cantly progressed or even irreversible. 2However, liver disease screening in individuals with heavy alcohol use is currently not standard in primary care, in part because no major primary care organizations have followed the ACG in endorsing this practice.In this commentary, we make the case that screening patients with heavy alcohol use for liver disease is a valuable tool for primary care clinicians to consider.To this end, we review the existing literature on screening methods, outline ongoing research that will inform this topic in the future, and propose a simple screening pathway for primary care. PREVALENCE OF ALCOHOL-RELATED LIVER DISEASE IS INCREASINGApproximately 2.6% of Americans, or 5.7 million people, have cirrhosis, 3 and it is estimated that 45% of cirrhosis diagnoses are related to alcohol use. 4 The prevalence of cirrhosis has doubled over the past decade, and once patients progress to end-stage liver disease (also known as decompensated cirrhosis), their prognosis is grim. 5Median survival for patients with decompensated cirrhosis is comparable to, if not worse than, many advanced cancers.Unlike most cancers, Preventing cirrhosis: Why primary care clinicians should screen for liver disease in patients who drink heavily on February 5, 2026.For personal use only.All other uses require permission.www.ccjm.