Background and Aims:Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease.Diabetes mellitus (DM) is a common comorbidity among NAFLD patients.We performed this study with the sp...Background and Aims:Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease.Diabetes mellitus (DM) is a common comorbidity among NAFLD patients.We performed this study with the specific aim to examine the impact of DM on progression of alcoholic liver disease (ALD) liver and NAFLD.Methods:Medical charts of 480 patients with ALD or NAFLD (2004-2011) managed at a tertiary center were retrospectively reviewed.NAFLD was diagnosed based on exclusion of other causes of liver disease and alcohol use of <10 g/d.ALD was diagnosed based on alcohol use of >40 g/d in women or >60 g/d in men for >5years.Results:Of 480 patients (307 NAFLD),200 diabetics differed from nondiabetics for:age (52±11 vs.49±11 years;p=0.004);male gender (48% vs.57%;p=0.03);metabolic syndrome (49% vs.30%;p=0.0002);NAFLD (80% vs.56%;p<0.0001);cirrhosis (70% vs.59%;p=0.005);and hepatocellular carcinoma (HCC;8% vs.3%;p=0.009).Over a 3 year median follow-up period,diabetics relative to nondiabetics had a higher probability to develop cirrhosis (60% vs.41%;p=0.022) and HCC (27% vs.10%;p=0.045).There was a trend for increased development of hepatic encephalopathy in diabetics compared to nondiabetics (55% vs.39%;p=0.053),and there was no difference between the two groups in survival or other liver disease complications.Conclusions:DM increased risk for cirrhosis and HCC among patients with ALD and NAFLD.Prospective studies with longer follow-up periods are needed to examine the impact of DM on survival and the role of aggressive HCC screening in diabetic cirrhotics.展开更多
Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indicatio...Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps t展开更多
Alcohol is a leading cause of liver disease and is associated with significant morbidity and mortality.Several factors,including the amount and duration of alcohol consumption,affect the development and progression of...Alcohol is a leading cause of liver disease and is associated with significant morbidity and mortality.Several factors,including the amount and duration of alcohol consumption,affect the development and progression of alcoholic liver disease (ALD).ALD represents a spectrum of liver pathology ranging from fatty change to fibrosis to cirrhosis.Early diagnosis of ALD is important to encourage alcohol abstinence,minimize the progression of liver fibrosis,and manage cirrhosis-related complications including hepatocellular carcinoma.A number of questionnaires and laboratory tests are available to screen for alcohol intake.Liver biopsy remains the gold-standard diagnostic tool for ALD,but noninvasive accurate alternatives,including a number of biochemical tests as well as liver stiffness measurement,are increasingly being utilized in the evaluation of patients with suspected ALD.The management of ALD depends largely on complete abstinence from alcohol.Supportive care should focus on treating alcohol withdrawal and providing enteral nutrition while managing the complications of liver failure.Alcoholic hepatitis (AH) is a devastating acute form of ALD that requires early recognition and specialized tertiary medical care.Assessment of AH severity using defined scoring systems is important to allocate resources and initiate appropriate therapy.Corticosteroids or pentoxifylline are commonly used in treating AH but provide a limited survival benefit.Liver transplantation represents the ultimate therapy for patients with alcoholic cirrhosis,with most transplant centers mandating a 6 month period of abstinence from alcohol before listing.Early liver transplantation is also emerging as a therapeutic measure in specifically selected patients with severe AH.A number of novel targeted therapies for ALD are currently being evaluated in clinical trials.展开更多
文摘Background and Aims:Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease.Diabetes mellitus (DM) is a common comorbidity among NAFLD patients.We performed this study with the specific aim to examine the impact of DM on progression of alcoholic liver disease (ALD) liver and NAFLD.Methods:Medical charts of 480 patients with ALD or NAFLD (2004-2011) managed at a tertiary center were retrospectively reviewed.NAFLD was diagnosed based on exclusion of other causes of liver disease and alcohol use of <10 g/d.ALD was diagnosed based on alcohol use of >40 g/d in women or >60 g/d in men for >5years.Results:Of 480 patients (307 NAFLD),200 diabetics differed from nondiabetics for:age (52±11 vs.49±11 years;p=0.004);male gender (48% vs.57%;p=0.03);metabolic syndrome (49% vs.30%;p=0.0002);NAFLD (80% vs.56%;p<0.0001);cirrhosis (70% vs.59%;p=0.005);and hepatocellular carcinoma (HCC;8% vs.3%;p=0.009).Over a 3 year median follow-up period,diabetics relative to nondiabetics had a higher probability to develop cirrhosis (60% vs.41%;p=0.022) and HCC (27% vs.10%;p=0.045).There was a trend for increased development of hepatic encephalopathy in diabetics compared to nondiabetics (55% vs.39%;p=0.053),and there was no difference between the two groups in survival or other liver disease complications.Conclusions:DM increased risk for cirrhosis and HCC among patients with ALD and NAFLD.Prospective studies with longer follow-up periods are needed to examine the impact of DM on survival and the role of aggressive HCC screening in diabetic cirrhotics.
文摘Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps t
基金This work was supported in part by a grant from the National Institute on Alcohol Abuse and Alcoholism (U01AA021893) to Arthur McCullough
文摘Alcohol is a leading cause of liver disease and is associated with significant morbidity and mortality.Several factors,including the amount and duration of alcohol consumption,affect the development and progression of alcoholic liver disease (ALD).ALD represents a spectrum of liver pathology ranging from fatty change to fibrosis to cirrhosis.Early diagnosis of ALD is important to encourage alcohol abstinence,minimize the progression of liver fibrosis,and manage cirrhosis-related complications including hepatocellular carcinoma.A number of questionnaires and laboratory tests are available to screen for alcohol intake.Liver biopsy remains the gold-standard diagnostic tool for ALD,but noninvasive accurate alternatives,including a number of biochemical tests as well as liver stiffness measurement,are increasingly being utilized in the evaluation of patients with suspected ALD.The management of ALD depends largely on complete abstinence from alcohol.Supportive care should focus on treating alcohol withdrawal and providing enteral nutrition while managing the complications of liver failure.Alcoholic hepatitis (AH) is a devastating acute form of ALD that requires early recognition and specialized tertiary medical care.Assessment of AH severity using defined scoring systems is important to allocate resources and initiate appropriate therapy.Corticosteroids or pentoxifylline are commonly used in treating AH but provide a limited survival benefit.Liver transplantation represents the ultimate therapy for patients with alcoholic cirrhosis,with most transplant centers mandating a 6 month period of abstinence from alcohol before listing.Early liver transplantation is also emerging as a therapeutic measure in specifically selected patients with severe AH.A number of novel targeted therapies for ALD are currently being evaluated in clinical trials.
