Alcoholic Hepatitis B
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6.14 Alcohol Use Disorders and Alcoholic Liver Disease
6. Priority diseases and reasons for inclusion 6.14 Alcohol use disorders and alcoholic liver disease See Background Paper 6.14 (BP6_14Alcohol.pdf) Background The WHO estimates that alcohol is now the third highest risk factor for premature mortality, disability and loss of health worldwide.1 Between 2004 to 2006, alcohol use accounted for about 3.8% of all deaths (2.5 million) and about 4.5% (69.4 million) of Disability Adjusted Life Years (DALYS).2 Europe is the largest consumer of alcohol in the world and alcohol consumption in this region emerges as the third leading risk factor for disease and mortality.3 In European countries in 2004, an estimated one in seven male deaths (95 000) and one in 13 female deaths (over 25 000) in the 15 to 64 age group were due to alcohol-related causes.3 Alcohol is a causal factor in 60 types of diseases and injuries and a contributing factor in 200 others, and accounts for 20% to 50% of the prevalence of cirrhosis of the liver. Alcohol Use Disorders (AUD) account for a major part of neuropsychiatric disorders and contribute substantially to the global burden of disease. Alcohol dependence accounts for 71% of all alcohol-related deaths and for about 60% of social costs attributable to alcohol.4 The acute effects of alcohol consumption on the risk of both unintentional and intentional injuries also have a sizeable impact on the global burden of disease.2 Alcoholic liver disease (ALD) is the commonest cause of cirrhosis in the western world, and is currently one of the ten most common causes of death.5 Liver fibrosis caused by alcohol abuse and its end stage, cirrhosis, present enormous problems for health care worldwide. -
Alcoholic Liver Disease and Its Relationship with Metabolic Syndrome
Research and Reviews Alcoholic Liver Disease and Its Relationship with Metabolic Syndrome JMAJ 53(4): 236–242, 2010 Hiromasa ISHII,*1 Yoshinori HORIE,*2 Yoshiyuki YAMAGISHI,*3 Hirotoshi EBINUMA*3 Abstract Alcoholic liver disease (ALD), which occurs from chronic excessive drinking, progresses from initial alcoholic fatty liver to more advanced type such as alcoholic hepatitis, liver fibrosis, or liver cirrhosis when habitual drinking continues. In general, chance of liver cirrhosis increases after 20 years of chronic heavy drinking, but liver cirrhosis can occur in women after a shorter period of habitual drinking at a lower amount of alcohol. Alcoholic liver cirrhosis accounts for approximately 20% of all liver cirrhosis cases. The key treatment is abstinence or substantial cutting down on drinking; the prognosis is poor if the patient continues drinking after being diagnosed with liver cirrhosis. Factors that exert adverse effects on the progression of ALD include gender difference, presence of hepatitis virus, immunologic abnormality, genetic polymorphism of alcohol-metabolizing enzymes, and complication of obesity or overweight. Recently, particular attention has been paid to obesity and overweight as risk factors in the progression of ALD. Conditions such as visceral fat accumulation, obesity, and diabetes mellitus underlie the pathologic factor of metabolic syndrome (MetS). In liver, MetS may accompany fatty liver or steatohepatitis, with possible progression to liver cirrhosis in some cases. Caution is required for patients with MetS who have a high alcohol intake because alcohol consumption further accelerates the progression of liver lesions. Key words Alcoholic liver disease, Metabolic syndrome, Obesity, NAFLD/NASH Introduction following hypertension and smoking, as a global disease burden. -
Diagnosis and Management of Autoimmune Hemolytic Anemia in Patients with Liver and Bowel Disorders
Journal of Clinical Medicine Review Diagnosis and Management of Autoimmune Hemolytic Anemia in Patients with Liver and Bowel Disorders Cristiana Bianco 1 , Elena Coluccio 1, Daniele Prati 1 and Luca Valenti 1,2,* 1 Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; [email protected] (C.B.); [email protected] (E.C.); [email protected] (D.P.) 2 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy * Correspondence: [email protected]; Tel.: +39-02-50320278; Fax: +39-02-50320296 Abstract: Anemia is a common feature of liver and bowel diseases. Although the main causes of anemia in these conditions are represented by gastrointestinal bleeding and iron deficiency, autoimmune hemolytic anemia should be considered in the differential diagnosis. Due to the epidemiological association, autoimmune hemolytic anemia should particularly be suspected in patients affected by inflammatory and autoimmune diseases, such as autoimmune or acute viral hepatitis, primary biliary cholangitis, and inflammatory bowel disease. In the presence of biochemical indices of hemolysis, the direct antiglobulin test can detect the presence of warm or cold reacting antibodies, allowing for a prompt treatment. Drug-induced, immune-mediated hemolytic anemia should be ruled out. On the other hand, the choice of treatment should consider possible adverse events related to the underlying conditions. Given the adverse impact of anemia on clinical outcomes, maintaining a high clinical suspicion to reach a prompt diagnosis is the key to establishing an adequate treatment. Keywords: autoimmune hemolytic anemia; chronic liver disease; inflammatory bowel disease; Citation: Bianco, C.; Coluccio, E.; autoimmune disease; autoimmune hepatitis; primary biliary cholangitis; treatment; diagnosis Prati, D.; Valenti, L. -
Hepatitis C and Alcohol
Hepatitis C and Alcohol Eugene R. Schiff, M.D., and Nuri Ozden, M.D. Patients infected with the hepatitis C virus (HCV) who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCV-infected patients. Research areas that have the greatest potential for developing more effective treatment options include HCV virology, immunology, animal models, and the mechanisms of liver injury. KEY WORDS: hepatitis C virus; alcoholic beverage; chronic AODE (alcohol and other drug effects); amount of AOD use; epidemiology; risk factors; disease course; alcoholic liver cirrhosis; gender differences; biochemical mechanism; RNA; mutation; apoptosis; inflammation; hepatocellular carcinoma; regulatory proteins; immune response; alcoholic fatty liver; treatment issues; treatment outcome; interferon epatitis C is an infectious liver the time of infection, male gender, are considerably more likely to test disease caused by the hepatitis obesity, abnormal accumulation of fat positive for HCV infection than those HC virus (HCV). The virus, in the liver (a condition known as fatty with less severe liver disease (Takase et which causes inflammation in the liver liver, or steatosis), and excessive alco al. 1993). and can lead to more serious illness, hol consumption (Poynard et al. 2001). primarily is spread by intravenous This article discusses the mechanisms contact with the blood of an infected by which alcohol may exacerbate Levels of Alcohol person. About 4 million people in the HCV-infected patients’ risk of disease Consumption in HCV United States have been infected, progression, reviews issues in the Patients and the Risk of making it the Nation’s most common treatment of alcoholic patients with Further Liver Disease blood-borne disease, resulting in the HCV infection, and addresses impor deaths of between 10,000 and 12,000 tant areas of future research. -
Alcoholic Liver Disease Postgrad Med J: First Published As 10.1136/Pmj.76.895.280 on 1 May 2000
280 Postgrad Med J 2000;76:280–286 Alcoholic liver disease Postgrad Med J: first published as 10.1136/pmj.76.895.280 on 1 May 2000. Downloaded from Kevin Walsh, Graeme Alexander Abstract Alcohol is a major cause of liver cirrhosis Box 1: Safe limits for alcohol intake in the Western world and accounts for the x Males = 21 units per week (1 unit = majority of cases of liver cirrhosis seen in glass or half pint) district general hospitals in the UK. The x Females = 14 units per week three most widely recognised forms of alcoholic liver disease are alcoholic fatty liver (steatosis), acute alcoholic hepatitis, and alcoholic cirrhosis. The exact patho- genesis of alcoholic liver injury is still not Box 2: Factors increasing susceptibility clear but immune mediated and free to ALD radical hepatic injury are thought to be x Lifetime intake of alcohol important. There is increasing interest in genetic factors predisposing to hepatic x Female sex injury in susceptible individuals. Diagno- x Genetic factors sis is based on accurate history, raised x Drinking without food serum markers such as ã-glutamyl- Binge drinking transferase, mean corpuscular volume, x and IgA and liver histology when x High concentration alcoholic drinks—for obtainable. Abstinence is the most example, spirits important aspect of treatment. Newer x Drinking multiple diVerent alcoholic drugs such as acamprosate and naltrex- beverages one are used to reduce alcohol craving. Vitamin supplements and nutrition are vital while corticosteroids have a role in acute alcoholic hepatitis where there Danish subjects found that ALD was increased is no evidence of gastrointestinal above a threshold of 7–13 drinks per week in haemorrhage or sepsis. -
Drinking and Liver Disease
IARD RESEARCH REVIEW HEALTH REVIEW REVIEW TITLE Drinking and Liver Disease BACKGROUND Liver Disease in Context TERMS AND CONCEPTS There are over 100 types of liver disease, many of which are quite rare. This review will focus on alcohol-related Alcohol-related liver disease (also liver diseases (also called alcoholic liver disease), a term called alcoholic liver disease) is an used to identify three liver conditions associated with heavy drinking [1, 2]. umbrella term used to identify three liver conditions associated with heavy • Alcoholic fatty liver disease is characterized by a buildup of fatty tissue in the liver, and is generally drinking: alcoholic fatty liver disease, reversible if alcohol consumption ceases. alcoholic hepatitis, and alcoholic • Alcoholic hepatitis involves inflammation and mild scarring of the liver. Damage caused by this form of cirrhosis. hepatitis is also potentially reversible. • Alcoholic cirrhosis, in which normal liver tissue is Morbidity is a measure of disease in a replaced by extensive scar tissue, is the most serious particular population. form of alcohol-related liver disease. Mortality is a measure of death in a Most heavy drinkers progress through the diseases starting with alcohol fatty liver disease, then alcoholic given population. hepatitis, and ending with alcoholic cirrhosis; however, some alcoholics may bypass alcoholic hepatitis [1]. This IARD Health Review aims to summarize the current literature surrounding the relationship between heavy alcohol consumption and alcohol-related liver disease. SUMMARY OF THE LITERATURE Drinking patterns and risk Alcohol-related liver disease is linked to the pattern of alcohol consumption [2, 3]. • Between 90% and 100% of heavy drinkers develop fatty liver disease. -
Zieve's Syndrome and Hemochromatosis, Are They Related? Rossi S* and Schiavone C Unit of Diagnostic Ultrasound, “G
icine: O ed pe M n l A a r c e c e n s e s G Rossi and Schiavone, General Med 2015, 3:3 General Medicine: Open Access DOI: 10.4172/2327-5146.1000181 ISSN: 2327-5146 Case Report Open Access Zieve's Syndrome and Hemochromatosis, are they Related? Rossi S* and Schiavone C Unit of Diagnostic Ultrasound, “G. d’Annunzio” University, 66013 Chieti Scalo (CH), Italy *Corresponding author: Rossi Stefano, Unit of diagnostic Ultrasound, “G. d’Annunzio” University, 66013 Chieti Scalo (CH), Italy, Tel: +39-871-358576; Fax: +39-871-358969; E-mail: [email protected] Rec date: May 19, 2015 Acc date: June 10, 2015 Pub date: June 15, 2015 Copyright: © 2015 Rossi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Case Report A 42 years old man with alcoholic liver cirrhosis was admitted to our hospital for the persistence of a few days of gingival bleeding, jaundice and abdominal pain. The patient reported a recent alcohol abuse. At physical examination was revealed the presence of scleral jaundice, hepatosplenomegaly, gengiva bleeding and bronzed skin. At laboratory tests was showed an increase in total bilirubin (10.20 mg/dL) mainly of direct fraction (7.60 mg/dL), amylase (152 U/L), lipase (936 U/L), transaminases (GOT 400 U/L and GPT 165 U/L), GGT (326 U/L), alkaline phosphatase (333 U/L), PCR 6.2 mg/dL, macrocytic anaemia (Hb 7.7 g/dL, MCV 109.5 fL), INR 2. -
Liver Transplantation for Alcoholic Liver Disease and Hepatocellular Carcinoma
cancers Review Liver Transplantation for Alcoholic Liver Disease and Hepatocellular Carcinoma Patrizia Burra *, Alberto Zanetto and Giacomo Germani Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy; [email protected] (A.Z.); [email protected] (G.G.) * Correspondence: [email protected]; Tel.: +39-049-821-2892; Fax: +39-049-821-8727 Received: 18 December 2017; Accepted: 7 February 2018; Published: 9 February 2018 Abstract: Hepatocellular carcinoma is one of the main important causes of cancer-related death and its mortality is increasingly worldwide. In Europe, alcohol abuse accounts for approximately half of all liver cancer cases and it will become the leading cause of hepatocellular carcinoma in the next future with the sharp decline of chronic viral hepatitis. The pathophysiology of alcohol-induced carcinogenesis involves acetaldehyde catabolism, oxidative stress and chronic liver inflammation. Genetic background plays also a significant role and specific patterns of gene mutations in alcohol-related hepatocellular carcinoma have been characterized. Survival is higher in patients who undergo specific surveillance programmes than in patients who do not. However, patients with alcohol cirrhosis present a significantly greater risk of liver decompensation than those with cirrhosis due to other aetiologies. Furthermore, the adherence to screening program can be suboptimal. Liver transplant for patients with Milan-in hepatocellular carcinoma represents the best possible treatment in case of tumour recurrence/progression despite loco-regional or surgical treatments. Long-term result after liver transplantation for alcohol related liver disease is good. However, cardiovascular disease and de novo malignancies can significantly hamper patients’ survival and should be carefully considered by transplant team. -
Pathophysiology and Management of Alcoholic Liver Disease: Update 2016
Gut and Liver, Vol. 11, No. 2, March 2017, pp. 173-188 Review Pathophysiology and Management of Alcoholic Liver Disease: Update 2016 Felix Stickel1, Christian Datz2, Jochen Hampe3, and Ramon Bataller4 1Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland, 2Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria, 3Medical Department 1, University Hospital Dresden, TU Dresden, Dresden, Germany, and 4Division of Gastroenterology and Hepatology, Department of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Alcoholic liver disease (ALD) is a leading cause of cirrhosis, PNPLA3 liver cancer, and acute and chronic liver failure and as such causes significant morbidity and mortality. While alcohol INTRODUCTION consumption is slightly decreasing in several European coun- tries, it is rising in others and remains high in many coun- Alcohol consumption accounts for approximately 3.8% of all tries around the world. The pathophysiology of ALD is still global deaths and 4.6% of global disability-adjusted life-years.1 incompletely understood but relates largely to the direct toxic In Europe, this problem seems to be particularly relevant, with effects of alcohol and its main intermediate, acetaldehyde. 6.5% of all deaths attributable to alcohol,2 and recent estimates Recently, novel putative mechanisms have been identified indicate that harmful drinking, particularly when associated in systematic scans covering the entire human genome and with alcohol dependence, is responsible for one in seven deaths raise new hypotheses on previously unknown pathways. The in men and one in 13 deaths in women aged 15 to 64 years.3 latter also identify host genetic risk factors for significant liver Alcohol use disorders (AUD) are the most frequent cause of liver injury, which may help design prognostic risk scores. -
Fatty Liver Disease
Fatty Liver Disease Almost all the organs of the body contain some fat. Fat cells provide insulation, protection, and are an efficient way to store extra energy. After a typical meal, dietary fat is absorbed by the intestines and enters the blood stream which carries the fat directly to the liver. Normally, this fat is metabolized in the liver and converted to energy. If the amount of fat delivered is excessive, it is stored in the liver and other tissues. The normal liver contains about five percent fat. The rest of the liver is made up of liver cells called hepatocytes which do all the work of the liver. When the amount of fat in the liver exceeds 10 percent, healthy liver cells are replaced by fat cells. This condition is termed a fatty liver disease, or steatosis. Incidence of Fatty Liver Disease Recent surveys have shown fatty liver to be much more common than previously recognized. It now affects about 23 percent of adult Americans and has become the most common cause of abnormal liver blood tests in the US population. Risk Factors for Fatty Liver Disease The typical patient is an older, obese woman who may be diabetic, but fatty liver affects both sexes and may occur in those of normal weight. It is also quite common in those who consume excessive amounts of alcohol. Natural History of Fatty Liver Disease There are two types of fatty liver – that seen in alcoholics and that which occurs in non-drinkers. It has been recognized for centuries that chronic alcoholism can cause progressive liver failure. -
The History of Alcoholic Liver Disease: from an Unrecognized Disease to One of the Most Frequent Diseases in Hepatology
Journal of Clinical Medicine Review The History of Alcoholic Liver Disease: From an Unrecognized Disease to One of the Most Frequent Diseases in Hepatology Helmut K. Seitz 1,2,* and Manuela G. Neuman 3 1 Centre of Liver and Alcohol Diseases, Ethianum Clinic, 69115 Heidelberg, Germany 2 Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany 3 In Vitro Drug Safety and Biotechnology and the Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L5, Canada; [email protected] * Correspondence: [email protected] Abstract: This review describes the history of alcoholic liver disease from the beginning of the 1950s until now. It details how the hepatotoxicity of alcohol was discovered by epidemiology and basic research primarily by using new feeding techniques in rodents and primates. The article also recognizes the pioneering work of scientists who contributed to the understanding of the pathophysiology of alcoholic liver disease. In addition, clinical aspects, such as the development of diagnostics and treatment options for alcoholic liver disease, are discussed. Up-to-date knowledge of the mechanism of the disease in 2020 is presented. Keywords: alcoholic liver disease; chronic alcohol consumption; hepatotoxicity; liver biopsy; liver inflammation Citation: Seitz, H.K.; Neuman, M.G. 1. Introduction The History of Alcoholic Liver Disease: From an Unrecognized Chronic alcohol consumption is responsible for more than 200 diseases [1]. Among Disease to One of the Most Frequent them, alcoholic liver disease (ALD) is one of the most frequent and most serious complica- Diseases in Hepatology. J. Clin. Med. tions of chronic alcohol intake. -
Progress Report Treatment of Acute Alcoholic Hepatitis'
Gut: first published as 10.1136/gut.13.1.68 on 1 January 1972. Downloaded from Gut, 1972, 13, 68-73 Progress report Treatment of acute alcoholic hepatitis' The lesion of acute hepatocyte injury related to alcohol, consisting of swelling and degeneration of liver cells and alcoholic hyaline and poly- morphonuclear infiltration, was initially described by Mallory in 1911.1 Subsequently, it has been referred to by various descriptions, including 'florid cirrhosis', 'acute hepatic insufficiency of the alcoholic', 'steatonecrosis', and 'acute sclerosing hyaline necrosis'. The most up-to-date clinical name for this entity acute alcoholic hepatitis was established only 10 years ago by Beckett, Livingstone, and Hill.2 In spite of the high frequency of this clinicopathological disorder, interest in its management as judged by clinical reports has waned remarkably. A review of the literature over the past five years indicates that papers pertaining to therapy of the liver itself (excluding complications of liver failure) have averaged one annually in Anglo-American scientific publications. Treatment has been largely empirical, based upon tradition, conservatism, and the avoidance of iatrogenic problems. Therapeutic Goals http://gut.bmj.com/ Three distinct but overlapping aims of treatment may be recognized in the management of alcoholic hepatitis. Reduction of mortality, avoidance of cirrhosis, and removal of hepatic fat are separate yet interrelated criteria by which the efficacy of new agents may be judged. If a consensus is to be sought, clinical trials must be structurally sound in terms of therapeutic intent. For example, when considering immediate survival as an indicator on September 28, 2021 by guest.