Although multimorbidity prevention is now recognised as a high priority , and forms part of the National Health Service (NHS) Long Term Plan , there are few established strategies with known effectiveness. Disease prevention is particularly challenging when conditions develop over a long period of time without symptoms, meaning that disease is often only detected once it has progressed to advanced stages. Therefore, when it comes to multimorbidity prevention, a proactive—rather than reactive—approach may be required . More information and support for people with alcoholic liver disease and their families can be found by joining support groups for alcoholism or liver disease. Today’s UChicago Medicine physicians, researchers and members of our hepatology team build on more than eight decades of experience, discoveries and treatment innovations related to liver disease. Some people with liver disease have related medical problems in other areas, such as diabetes, kidney disease or heart disease.
- When lipid oxidation (lipolysis) stops due to alcohol consumption, fats accumulate in the liver and lead to "fatty liver disease." Continued alcohol consumption brings the immune system into play.
- Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited.
- Although stopping drinking alcohol is the most effective treatment for alcoholic liver disease, it is not a complete cure.
- With continued excessive alcohol ingestion, approximately one-third of patients with steatosis have histological evidence of hepatic inflammation (sometimes termed ASH) (29).
- Having hepatitis C or other liver diseases with heavy alcohol use can rapidly increase the development of cirrhosis.
All health professionals must coordinate their actions to improve the management of the patient with severe alcohol addiction, which is responsible for alcoholic liver disease. Psychologists and psychiatrists must be asked by clinicians to assess the psychological state of patients to determine the origin of alcohol intoxication (depression, post-traumatic shock). Outside medical treatment, patient education is the key to treatment for patients with alcoholic liver disease. Varices in the esophagus and stomach are present in about half of all cirrhosis patients. Each year, 5 percent to 20 percent of patients with cirrhosis experience the formation of varices. Once varices have been formed, 5 percent to 15 percent become large varices (Garcia and Sanyal 2001).
LIVER TRANSPLANTATION IN ALCOHOLIC LIVER DISEASE
However, these abate with abstinence, usually within a month, though there is a protracted abstinence syndrome that can persist for months(81). This may be particularly challenging in those patients with alcohol use disorder and HCV infection who are taking DAAs, which are substrates as well as inhibitors of cytochrome P450 3A4 and P-glycoprotein. There are clinically important drug-drug interactions between these drugs and common medications used to treat withdrawal (e.g., alprazolam; midazolam), sleep problems (e.g., zolpidem; trazodone), and psychiatric symptoms (e.g., escitalopram; St John’s Wort; carbamazepine)(82). In summary, it now is generally possible to accurately diagnose ALD, and new biomarkers or identifier proteins for detecting ongoing alcohol abuse and ALD are being investigated, as is the role of genetics in ALD. Although there are no FDA-approved therapies for alcoholic liver disease, lifestyle changes, nutritional support, and “off-label” therapies such as PTX can improve outcome. Similarly, new therapies for complications are improving quality of life and, in some cases, even reducing mortality rates.
Self-reported alcohol use is often unreliable ( 159,172 ), and biomarkers of alcohol consumption can help in identifying patients with ongoing alcohol consumption (please refer to the section on ‘Diagnosis of AUD’). LT is a definitive therapy for patients with cirrhosis and endstage alcoholic liver disease liver disease. Alcoholic cirrhosis is the third most common indication for LT after hepatitis C and non-alcoholic fatty liver disease. LT for alcohol related cirrhosis accounts for about 15% of all liver transplants in the United States and about 20% in Europe ( 145–147 ).
“Most Wired” for acute care
The clinical literature summarized here indicates that treatments for patients with alcoholic liver disease exist and providing these treatments is critical. To this end, it is important to educate physicians in addiction medicine (86). The National Institute on Alcohol Abuse and Alcoholism has developed several professional education materials for health care providers(87).
These patients are also at an increased risk of developing HCC, with a life-time risk of about 3–10% and an annual risk of about 1%. Obesity and cigarette smoking are risk factors for HCC in patients with alcoholic cirrhosis. Patients with alcoholic cirrhosis should undergo screening with ultrasound examination with or without α-fetoprotein testing every 6 months for HCC (51). Immunization against hepatitis A and B, pneumococcal pneumonia and influenza is also recommended (Center for Disease Control and Prevention link on vaccinations). A proportion of patients with evidence of steatohepatitis on liver biopsy develop hepatic fibrosis (20–40%) and cirrhosis (8–20%).