Alcohol use disorder and the liver (original) (raw)
Related papers
Seminars in Liver Disease, 2009
A lcohol (ethanol) is one of the most commonly abused drugs throughout the world. In the United States, about half of the adult population actively consumes alcoholic beverages and about 15 to 20 million people suffer from alcoholism (1). According to a 1990 survey by the US Department of Health and Human Services, alcohol is the third leading cause of preventable mortality, behind cigarette smoking and obesity, with about 100,000 deaths annually and an annual economic burden of more than $100 billion in the US (2,3). Alcohol consumption can lead to a variety of abnormalities in the liver including steatosis, alcoholic hepatitis, and hepatic fibrosis, which typically precede the development of alcoholic cirrhosis, an end-stage liver disease most often requiring liver transplantation. Alcoholic cirrhosis is also a major risk factor for hepatocellular carcinoma that accounts for nearly 6% of all human cancers. Alcoholic liver disease affects more than 2 million people in the United States. According to a US surveillance report, liver cirrhosis was the 10 th leading cause of mortality in 1997 accounting for approximately 25,000 deaths in that year (4). Another 10,000 died of liver cancer, which in the majority of the cases involves underlying cirrhosis.
Annals of Hepatology, 2019
Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy.
The undertreatment of alcohol-related liver diseases among people with alcohol use disorder
DOAJ (DOAJ: Directory of Open Access Journals), 2020
Harmful and hazardous alcohol consumption is one of the most significant public health problems in Italy and Europe. Habitual excessive consumption and occasional excessive consumption, known as binge drinking, are the two main risk behaviours related to alcohol. Harmful drinking and alcohol dependence have strong social repercussions in terms of their social and economic impact and contribution to productivity losses. In addition, the terms alcohol abuse and alcohol dependence have been recently substituted by the only term of alcohol use disorder (AUD). The issues presented in this review demonstrate that excessive alcohol consumption is a growing public health concern and an appropriate national action plan is needed to increase the prevention of harmful and hazardous consumption and encourage patients to seek healthcare. To date, the main problem is the under-treatment of the population at risk, manifested as the time-lag between the onset of AUD and the first clinical detection. In order to address this, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shared across countries in Europe and is supported by a Systematic Review of Reviews on SBIRT in primary healthcare. Unfortunately, there are still obstacles in the implementation of this approach. The main problem would appear to be general practitioners' difficulty in carrying out accurate and widespread screening, because they may minimize the problem. A more concerted effort in the training of healthcare professionals could address this by enabling the creation of renewed networks for the early identification of harmful and hazardous drinkers. These networks could prevent the occurrence of avoidable alcohol-related conditions, such as alcohol-related liver disease (ALD), while allowing for the timely implementation of evidence-based brief interventions.
Alcoholic liver diseases and their therapy
2018
Alcohol related toxicity is the third most common cause of morbidity and the fifth most common cause of disease burden worldwide. Alcoholic liver diseases (ALD) are the leading cause of mortality in people aged 15–49 years. Fatty liver develops in about 90% of individuals who drinks more than 60 g/day of alcohol. Many heavy drinkers will progress from fatty liver to alcoholic hepatitis and finally to alcoholic cirrhosis over time. The cornerstone of therapy of alcoholic hepatitis is abstinence. However, other therapies like naltrexone and baclofen found to improve abstinence and decrease relapse. An assured therapy of liver transplantation playing a vital role during end stage liver failure. It is the time now to make awareness regarding ALD among the public.
Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence
World Journal of Gastroenterology, 2015
Author contributions: Gutiérrez García ML contributed to the study idea, study design, literature search, manuscript writing and final revision of the article; Blasco-Algora S contributed to the study idea, study design, literature search, manuscript writing and final revision of the article; and Fernández-Rodríguez CM contributed to the study idea, study design, literature search, manuscript writing and final revision of the article.
Journal of Mind and Medical Sciences, 2019
Liver cirrhosis is a significant public health problem, being an important cause of mortality and morbidity, responsible for approximately 1.8% of the total number of deaths in Europe. Chronic alcohol consumption is the most common cause of liver cirrhosis in developed countries. Europe has the highest level of alcohol consumption among all the global World Health Organisation (WHO) regions. In this paper, we briefly review major factors leading to excessive alcohol consumption in order to draw attention to the fact that alcoholic liver cirrhosis is more than a simple liver disease, and if those risk/causal factors can be prevented, the incidence of this disease could be reduced greatly. Although excessive alcohol consumption is regarded as the cause of alcoholic liver cirrhosis, the etiology is complex, involving multiple factors that act in synchrony, and which, if prevented, could greatly reduce the incidence of this disease. Children of addicts are likely to develop an alcohol-related mental disorder; however, there is no "gene for alcoholism".
Multidisciplinary View of Alcohol Use Disorder: From a Psychiatric Illness to a Major Liver Disease
Biomolecules, 2016
Alcohol use disorder is a significant health problem being a cause of increased morbidity and mortality worldwide. Alcohol-related illness has a relevant economic impact on the society and a negative influence on the life of patients and their family members. Psychosocial support might be useful in the management of people affected by alcohol use disorder since psychiatric and pharmaceutical approaches show some limits. In fact, many drugs are accessible for the treatment of alcohol disorder, but only Baclofen is functional as an anti-craving drug in patients with advanced liver disease. The alcohol-related liver damage represents the most frequent cause of advanced liver disease in Europe, and it is the main cause of death among adults with high alcohol consumption. The multidisciplinary action of clinical-psychologists, psychiatrics and hepatologists, is essential in the management of patients with alcohol liver disease especially in the case of liver transplantation. In general, the multidisciplinary approach is necessary in prevention, in framing patients and in the treatment. More resources should be used in prevention and research with the main aim of decreasing the harmful alcohol consumption.
Drug and Alcohol Review, 2021
IssuesAlcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease.ApproachWe developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA.Key FindingsThe following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy‐drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. ...
Journal of Substance Abuse Treatment, 2021
Background: Alcohol cessation improves mortality in alcohol-associated liver disease (ALD), but access to treatment is limited. To address this gap, implementation and early feasibility and outcomes of a multidisciplinary ALD clinic are described. Methods: The clinic comprised a hepatologist, psychiatrist, psychologist, nurse, and social worker. Patients included those with alcohol-associated cirrhosis or acute alcoholic hepatitis who were not in the transplant evaluation process, who had less than 6 months' sobriety and willingness to engage in alcohol use treatment. Psychosocial metrics in addition to routine hepatic