PEth Offers an Objective—But Imperfect—Way to Detect Alcohol Use Disorder in SLD: Gut | October 2026

What Did the Study Find?

Investigators prospectively studied 607 adults with overweight or obesity, 55% of whom were women; mean age was 51.2 years and mean BMI 32.6 kg/m². Participants underwent standardized alcohol-use assessment, DSM-5 evaluation, phosphatidylethanol testing, MRI-proton density fat fraction and magnetic resonance elastography.

Steatotic liver disease was present in 71%: 96% had MASLD, 3% MetALD and 1% alcohol-associated liver disease. Overall alcohol use disorder prevalence was 5%, rising from 3.6% in MASLD to 42.9% in MetALD and 50% in alcohol-associated liver disease. PEth demonstrated an AUROC of 0.78 for identifying alcohol use disorder. A threshold of 43 ng/mL produced approximately 70% sensitivity and 91% specificity—meaning that a negative result could still miss nearly three in ten affected patients. Gut

Why Does It Matter?

Self-reported alcohol intake is frequently underestimated, yet accurate classification influences diagnosis, counselling and transplant assessment. PEth provides an objective adjunct, but neither a positive nor negative result should be interpreted without a confidential clinical interview and longitudinal context.

GastroAGI Takeaway

PEth ≥43 ng/mL can strengthen detection of clinically important alcohol exposure, but it is a conversation starter—not a stand-alone diagnosis or punitive transplant-screening tool.