Evidence
Surveillance decision
We will update the guideline on alcohol-use disorders: diagnosis and management of physical complications (NICE guideline CG100). The update will focus on treatment for acute alcohol withdrawal.
During the update process the committee will refresh and clarify the dose of thiamine and the role of oral or parenteral thiamine for people at high risk of developing, or with suspected, Wernicke's encephalopathy. This will impact upon recommendation 1.2.1.1, but may also impact on recommendations 1.2.1.2 to 1.2.1.4. The committee will also refresh language to avoid stigma terminologies (such as drinker and alcoholic) and make editorial amendments to bring the guideline in line with current service provision.
In addition, NICE will withdraw 3 recommendations from this guideline and incorporate those from the more recent NICE guideline on pancreatitis. A link will also be added to section 1.3 to highlight the NICE guideline on cirrhosis in over 16s: assessment and management. See the details in the editorial amendments section of this surveillance report.
The following table gives an overview of how evidence identified in surveillance might affect each area of the guideline, including any proposed new areas.
|
Section of the guideline |
New evidence identified |
Impact |
|
1.1 Acute alcohol withdrawal |
||
|
1.1.1 Admission to hospital |
No |
No |
|
1.1.2 Assessment and monitoring |
No |
No |
|
1.1.3 Treatment for acute alcohol withdrawal |
Yes |
Yes |
|
1.1.4 Management of delirium tremens |
Yes |
No |
|
1.1.5 Management of alcohol withdrawal seizures |
No |
No |
|
1.2 Wernicke's encephalopathy |
||
|
1.2 Wernicke's encephalopathy |
No |
No |
|
1.3 Alcohol-related liver disease |
||
|
1.3.1 Assessment and diagnosis of alcohol-related liver disease |
Yes |
No |
|
1.3.2 Referral for consideration of liver transplantation |
No |
No |
|
1.3.3 Corticosteroid treatment for alcohol-related harm |
Yes |
No |
|
1.3.4 Nutritional support for alcohol-related hepatitis |
Yes |
No |
|
1.4 Alcohol-related pancreatitis |
||
|
1.4.1 Diagnostics of chronic alcohol-related pancreatitis |
No |
No |
|
1.4.2 Pancreatic surgery versus endoscopy for chronic alcohol-related pancreatitis |
No |
No |
|
1.4.3 Prophylactic antibiotics for acute alcohol-related pancreatitis |
No |
No |
|
1.4.4 Nutritional support for acute alcohol-related pancreatitis |
No |
No |
|
1.4.5 Enzyme supplementation for chronic alcohol-related pancreatitis |
No |
No |
Reasons for the decision
This section provides a summary of the areas that will be updated and the reasons for the decision to update.
1.1 Acute alcohol withdrawal
New evidence has been identified on pharmacotherapies for acute alcohol withdrawal, in particular around adjuvant dexmedetomidine and barbiturates. However, it would seem prudent to undertake a review of all pharmacotherapies for acute alcohol withdrawal and provide a more complete picture of which are the most effective and cost-effective pharmacotherapies for acute alcohol withdrawal.
For further details and a summary of all evidence identified in surveillance, see appendix A.
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