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Alcohol's Role in Gastrointestinal Tract Disorders

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Alcohol's Role in Gastrointestinal Tract Disorders Alcohol’s Role in Gastrointestinal Tract Disorders CHRISTIANE BODE, PH.D., AND J. CHRISTIAN BODE, M.D. When alcohol is consumed, the alcoholic beverages first pass through the various segments of the gastrointestinal (GI) tract. Accordingly, alcohol may interfere with the structure as well as the function of GI-tract segments. For example, alcohol can impair the function of the muscles separating the esophagus from the stomach, thereby favoring the occurrence of heartburn. Alcohol-induced damage to the mucosal lining of the esophagus also increases the risk of esophageal cancer. In the stomach, alcohol interferes with gastric acid secretion and with the activity of the muscles surrounding the stomach. Similarly, alcohol may impair the muscle movement in the small and large intestines, contributing to the diarrhea frequently observed in alcoholics. Moreover, alcohol inhibits the absorption of nutrients in the small intestine and increases the transport of toxins across the intestinal walls, effects that may contribute to the development of alcohol-related damage to the liver and other organs. KEY WORDS: ethanol metabolism; AODE (alcohol and other drug effects); mouth; esophagus; stomach; intestine; gastric mucosa; intestinal mucosa; gastric lesion; gastric acid; gastrointestinal function; gastrointestinal absorption; muscle; neoplastic disease; toxins; free radicals; etiology; literature review mong the many organ systems intestinal bleeding (from lesions in the acute and chronic effects on GI-tract that mediate alcohol’s effects on stomach or small intestine) and diar- function and structure. A the human body and its health, rhea. Third, functional changes and This article reviews some of these the gastrointestinal (GI) tract plays a mucosal damage in the gut disturb the findings, focusing primarily on insights particularly important part. Several digestion of other nutrients as well as gained during the past 10 years. (For processes underlie this role. First, the their assimilation into the body, there- extensive reviews of the developments GI tract is the site of alcohol absorption by contributing to the malnutrition and into the bloodstream and, to a lesser weight loss frequently observed in CHRISTIANE BODE, PH.D., is professor extent, of alcohol breakdown and pro- and chief of the Section of Physiology alcoholics. Fourth, alcohol-induced duction. (For more information on of Nutrition (140), Hohenheim mucosal injuries—especially in the alcohol absorption, metabolism, and University, Stuttgart, Germany. upper small intestine—allow large production in the GI tract, see sidebar, pp. 82–83.) Second, the direct contact of molecules, such as endotoxin and other J. CHRISTIAN BODE, M.D., is professor alcoholic beverages with the mucosa1 bacterial toxins, to pass more easily of medicine and chief of the Section that lines the upper GI tract can induce into the blood or lymph. These toxic of Gastroenterology, Hepatology and numerous metabolic and functional substances can have deleterious effects Endocrinology in the Department of changes. These alterations may lead to on the liver and other organs. Internal Medicine, Robert-Bosch- Krankenhaus, Stuttgart, Germany. marked mucosal damage, which can Over the past three decades, re- result in a broad spectrum of acute and searchers have made major progress 1For a definition of this and other technical terms used chronic diseases, such as acute gastro- toward understanding alcohol’s many in this article, see the central glossary, pp. 93–96. 76 ALCOHOL HEALTH & RESEARCH WORLD Gastrointestinal Tract Disorders in this field up to the early 1980’s, see (figure 2). As the food mass moves Beazell and Ivy 1940; Bode 1980). through the small intestine, digestive enzymes secreted by the intestinal Tongue Oral cavity THE GI TRACT—AN OVERVIEW cells complete the chemical degrad- ation of nutrients into simple mole- Parotid The GI tract’s functions are to physi- cules that can be absorbed through the gland cally and chemically break down intestinal wall into the bloodstream. Pharynx ingested food, allow the absorption of What finally remains in the intestine nutrients into the bloodstream, and are primarily indigestible waste prod- Teeth excrete the waste products generated. ucts. These products progress into the The GI tract can be viewed as one large intestine, where the waste is Salivary continuous tube extending from the compacted and prepared for excretion glands mouth to the anus (figure 1), which is through the anus. Like the small in- Esophagus subdivided into different segments testine, the large intestine can be with specific functions. divided into three segments: the ce- Stomach In the mouth, or oral cavity, the teeth cum; the colon, which constitutes mechanically grind the food into small about 80 percent of the large intes- pieces. Moreover, saliva excreted by tine; and the rectum. The following Duodenum the salivary glands initiates the food’s sections review alcohol’s effect on the Jejunum chemical degradation. From the oral different regions of the GI tract. cavity, the food passes through the throat (i.e., pharynx) into the esophagus. The THE ORAL CAVITY coordinated contraction and relaxation AND THE ESOPHAGUS of the muscles surrounding the esopha- gus propels the food into the stomach. The oral cavity, pharynx, esophagus, In the stomach, the chemical degra- and stomach are exposed to alcohol Cecum dation of the food continues with the immediately after its ingestion. Thus, help of gastric acid and various diges- alcoholic beverages are almost undi- Large intestine tive enzymes. Excessive gastric acid luted when they come in contact with Ileum (colon) production can irritate the mucosa, the mucosa of these structures. It is Rectum Anal canal causing gastric pain, and result in the therefore not surprising that mucosal development of gastric ulcers. Two injuries (i.e., lesions) occur quite bands of muscle fibers (i.e., sphinc- frequently in people who drink large Figure 1 Schematic representation of ters) close off the stomach to the eso- amounts of alcohol.2 the human gastrointestinal tract. The phagus and the intestine. Weakness of Chronic alcohol abuse damages the small intestine comprises the duo- denum, the ileum, and the jejunum. the sphincter separating the stomach salivary glands and thus interferes from the esophagus allows the stom- with saliva secretion. In alcoholics this ach content to flow back into the eso- damage commonly manifests itself as poor nutrition or reflect alcohol’s phagus. This process, which is called an enlargement (i.e., hypertrophy) of direct effect on the mucosa. Finally, gastroesophageal reflux, can lead to the parotid gland, although the mecha- chronic alcohol abuse increases the heartburn as well as inflammation (i.e., nisms leading to this condition are incidence of tooth decay, gum disease, reflux esophagitis) and even to the unknown. Moreover, alcoholics may and loss of teeth (Kranzler et al. 1990). development of ulcers in the lower suffer from inflammation of the tongue Alcohol consumption can affect the part of the esophagus. (i.e., glossitis) and the mouth (i.e., esophagus in several ways. For exam- From the stomach, the food enters stomatitis). It is unclear, however, ple, alcohol distinctly impairs esophageal the small intestine, which is divided whether these changes result from motility, and even a single drinking into three segments: the duodenum, episode (i.e., acute alcohol consump- the jejunum, and the ileum. Like the 2The alcohol amount necessary to cause mucosal tion) significantly weakens the lower esophagus and stomach, the intestine injury varies significantly among individual drinkers esophageal sphincter. As a result, is surrounded by layers of muscles, and depends, for example, on whether alcohol consumption occurs on an empty stomach or is gastroesophageal reflux may occur, the rhythmic movements of which accompanied by a meal. Thus, no clear threshold and the esophagus’ ability to clear the help mix the food mass and push it exists above which alcohol exerts its adverse effects. refluxed gastric acid may be reduced. along the GI tract. The intestine’s However, the risk for adverse effects such as tissue Both of these factors promote the inner mucosal surface is covered with damage generally increases following the consump- occurrence of heartburn. Moreover, tion of more than 2 ounces of alcohol, which corre- small projections called villi, which sponds to approximately four standard drinks (i.e., some alcoholics exhibit an abnormali- increase the intestinal surface area “heavy” or “excessive” drinking). ty of esophageal motility known as a VOL. 21, NO. 1, 1997 77 functioning in several ways. For ex- ample, alcohol—even in relatively Small Intestine small doses—can alter gastric acid secretion, induce acute gastric mucos- al injury, and interfere with gastric Intestinal wall and intestinal motility. Gastric Acid Secretion Analyses in several animal species found that acute alcohol administration by mouth or by direct infusion into the Villi stomach (i.e., intragastrically) or the Submucosa blood (i.e., intravenously) can affect gastric acid secretion (Chari et al. 1993). The secretory response of the stomach Intestinal muscles varies considerably, however, depend- ing on the species studied and the alco- hol concentrations used. In healthy, nonalcoholic humans, intravenous alco- hol administration of 0.3 to 0.5 grams per kilogram (g/kg) body weight or Villi intragastric infusion of alcohol solutions with concentrations
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