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Testino G, Pellicano R, Caputo F. Alcohol consumption, alcohol use disorder and organ transplantation. Minerva Gastroenterol (Torino) 2023; 69:553-565. [PMID: 36222679 DOI: 10.23736/s2724-5985.22.03281-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In the present experience we have evaluated the link alcohol consumption/alcohol use disorder (AUD) and organ transplantation (OT) in order to provide adequate suggestions. The data used for the preparation of these recommendations are based on a detailed analysis of the scientific literature published before August 31, 2022 (Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted the guidelines/position papers of the scientific societies. With regard to the liver transplantation, there are position papers/guidelines that clearly define indications and contraindications for including the AUD patient in the transplant list. One of the major difficulties in this area is psychosocial assessment which can be influenced by stigma. To solve this problem, it is necessary to use objective tools. However, this assessment should be carried out after providing the patient and family adequate tools to be able to create or recreate reliable socio-family support. This behavior should also be used in the case of other OTs. For the latter, however, adequate guidelines must be created which at the moment do not exist or if there are, as in the case of heart transplantation, they are not sufficient. Even in the absence of obvious alcohol addiction, it is recommended to use alcohol use disorder identification test and to include the addiction specialist in the multidisciplinary transplant team. Besides, providing family members with the tools necessary to better support the patient is essential. They are patients with alcohol use disorder/ possible presence of psychopathological manifestations and alcohol-related pathology (cirrhosis, cardiomyopathy, liver-kidney disfunction, etc.). A cardiovascular and oncologic surveillance post-OT is recommended. For the selection of patients to be included in the list for non-LT (heart, lung, kidney, multivisceral, etc.) it is mandatory to include the diagnosis and treatment of AUDs in the guidelines. What has already been indicated for LT may be useful. Timing of alcoholic abstention in relation to clinical severity, optimal psychosocial activity, anticraving therapy in relation to the type of underlying disease and clinical severity. Close collaboration between scientific societies is required to better manage AUD patients who need OT.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy -
- Centro Studi Mutual-self-help, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy -
| | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
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TESTINO G, BALBINOT P, PELLICANO R. Unexplained falls in the elderly. Does alcohol consumption play a role? A warning to geriatricians. Minerva Med 2022; 113:719-720. [DOI: 10.23736/s0026-4806.21.07864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balbinot P, Bottaro LC, Pellicano R, Testino G. Local health company 3 Liguria (ASL3) introduces the GLU GLU test for alcohol use disorder identification (alcohol use disorder identification test). Minerva Gastroenterol (Torino) 2022; 68:234-235. [PMID: 35001608 DOI: 10.23736/s2724-5985.21.03116-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria c/o Polyclinic San Martino Hospital, Genova, Italy.,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy
| | - Luigi C Bottaro
- Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy.,General Direction ASL3 Liguria, Genova, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria c/o Polyclinic San Martino Hospital, Genova, Italy - .,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy
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Rosa GM, Scagliola R, Zoppoli G, Perna V, Buscaglia A, Berri A, Della Bona R, Porto I, Pellicano R, Testino G. May standard basal echocardiogram allow to obtain predictors of asymptomatic cardiac dysfunction in alcoholics? Minerva Med 2021; 112:786-791. [PMID: 34672172 DOI: 10.23736/s0026-4806.21.07848-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-lasting heavy alcohol intake has been progressively recognized as a leading cause of non-ischemic dilated cardiomyopathy, involving 10% of all people who use alcohol. It is of huge importance to identify the earliest markers of this dysfunction and it is known that the newest echocardiographic techniques such as speckle tracking may allow to do it. In this study we investigated if standard basal echocardiogram features allow to obtain predictors of asymptomatic cardiac dysfunction in alcoholics. METHODS A population of 80 consecutive asymptomatic alcoholics was enrolled. None presented history, signs or symptoms of cardiovascular disease. All of them underwent a conventional transthoracic mono-bidimensional and doppler echocardiography. RESULTS Our cohort did not present echocardiographic findings of increased left ventricular sizes, mass or relative wall thickness. Hence, a significant rate of systolic dysfunction was not found. Furthermore, statistical analysis displayed an inverse relationship between alcohol consumption and systolic pulmonary arterial pressure as well as between alcohol abuse and left atrium enlargement. This may be explained by a potential vasodilator mechanism occurring in the earliest stages of alcohol intake. On the contrary, a positive correlation with the E/A ratio was found, and this might be ascribed to state of high cardiac output determined by alcohol abuse. There were modes sex-related differences. CONCLUSIONS This study has demonstrated that standard echocardiography may allow to predict cardiac dysfunction in asymptomatic alcoholics, and sex-related differences may be identified in this regard. These data need to be confirmed by further studies involving larger population.
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Affiliation(s)
- Gian Marco Rosa
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy - Italian IRCCS Cardiovascular Network
| | - Riccardo Scagliola
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy
| | - Gabriele Zoppoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy - Italian IRCCS Cardiovascular Network.,Department of Internal Medicine (Di.M.I.) Internal Medicine and Oncology Unit, University of Genova, Genova, Italy
| | - Valentina Perna
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy
| | - Angelo Buscaglia
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy
| | - Alessandro Berri
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genova, Italy
| | - Roberta Della Bona
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy - Italian IRCCS Cardiovascular Network
| | - Italo Porto
- Department of Internal Medicine (Di.M.I.) Clinic of Cardiovascular Diseases, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy - Italian IRCCS Cardiovascular Network
| | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genova, Italy -
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TESTINO G, PELLICANO R. Body Mass Index, dental health status and alcohol consumption. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Testino G, Balbinot P, Pellicano R. Substances use disorders and liver injury: a concise review. Minerva Gastroenterol (Torino) 2021; 68:269-276. [PMID: 33971710 DOI: 10.23736/s2724-5985.21.02885-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substance use disorders (SUDs) are often associated with alcohol use disorders (AUDs) and psychiatric comorbidities. In addition, they are often subjected to polytherapy. For these reasons SUDs patients are at greater risk of developing liver disease. In this concise review, liver damage from amphetamines, cannabinoids, cocaine and opioids is analyzed and the need to identify a possible associated alcohol use disorder is also suggested. Early identification of liver fibrosis is required in SUDs patients. Fibrosis is the most significant predictor of both prognosis and long-term survival. Its identification helps to promote the abstention from substances and alcohol. Active use of heroin, cocaine and synthetic substances is an absolute controindication for liver transplantation. In cases of remission and adherence to a significant care path, the patient is reevaluated. An addiction specialist should be present within the transplant team. If this is not present, a close collaboration with an addiction unit is mandatory.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy
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Testino G, Fagoonee S, Caputo F, Pellicano R. The early identification of alcohol use disorders and liver injury: proposal for a diagnostic algorithm. Panminerva Med 2021; 63:361-367. [PMID: 33494566 DOI: 10.23736/s0031-0808.21.04272-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy - .,Italian Society on Alcohol (SIA), Bologna, Italy -
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Torino, Italy
| | - Fabio Caputo
- Italian Society on Alcohol (SIA), Bologna, Italy.,Unit of Internal Medicine, Cento Hospital, University of Ferrara, Ferrara, Italy
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Di Sarno R, Brigida A, Caprio GG, Ciardiello D, Dallio M, Sangineto M, Fagoonee S, Abenavoli L, Luzza F, Gravina AG, De Magistris L, Federico A, Loguercio C. Critical review on the use and abuse of alcohol. When the dose makes the difference. Minerva Med 2020; 111:344-353. [PMID: 32338485 DOI: 10.23736/s0026-4806.20.06584-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nowadays harmful alcohol consumption represents one of the most important risk factors for the development of several type of chronic and acute diseases in the western countries, contributing to a great number of deaths. Focusing the attention on cancer development and progression, the scientific community has a large consensus in declaring the existence of a harmful association between alcohol consumption and liver, breast, upper aerodigestive tract (mouth, oropharynx, hypopharynx, and esophagus), pancreas and colon cancer appearance. However the precise biological links by which the alcohol could be responsible for cancer initiation and progression are not fully understood yet, even if the International Agency for Research on Cancer (IARC) indicated both ethanol and acetaldehyde as carcinogen for humans. The possible explanation of the effect exerted by ethanol and acetaldehyde could be related to direct genotoxicity, hormonal disturbance, triggering of oxidative stress and inflammation. In this review, we examine the relationship between alcohol dosage and associated diseases, with focus on alcohol-related cancers. Furthermore, to understand the potential molecular mechanisms of these diseases, the results of in vivo experiments on animal models were discussed.
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Affiliation(s)
- Rosa Di Sarno
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Annalisa Brigida
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giuseppe G Caprio
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Davide Ciardiello
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marcello Dallio
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Moris Sangineto
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Antonietta G Gravina
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Laura De Magistris
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Alessandro Federico
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Carmelina Loguercio
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Testino G, Leone S, Pellicano R. Heart disease in patients suffering from alcohol related liver disease. Panminerva Med 2020; 64:289-290. [PMID: 32208411 DOI: 10.23736/s0031-0808.20.03889-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianni Testino
- SC Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o Polyclinic San Martino Hospital, Genoa, Italy -
| | - Silvia Leone
- SC Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o Polyclinic San Martino Hospital, Genoa, Italy
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Toma L, Stanciu AM, Zgura A, Bacalbasa N, Diaconu C, Iliescu L. Electrocardiographic Changes in Liver Cirrhosis-Clues for Cirrhotic Cardiomyopathy. ACTA ACUST UNITED AC 2020; 56:medicina56020068. [PMID: 32050594 PMCID: PMC7073951 DOI: 10.3390/medicina56020068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/15/2022]
Abstract
Background and Objectives: Cirrhotic cardiomyopathy is a chronic cardiac dysfunction associated with liver cirrhosis, in patients without previous heart disease, irrespective of the etiology of cirrhosis. Electrocardiography (ECG) is an important way to evaluate patients with cirrhosis and may reveal significant changes associated with liver disease. Our study aimed to evaluate ECG changes in patients with diagnosed liver cirrhosis and compare them to patients with chronic hepatitis. Materials and Methods: We evaluated laboratory findings and ECG tracings in 63 patients with cirrhosis and 54 patients with chronic hepatitis of viral etiology. The end points of the study were prolonged QT interval, QRS hypovoltage and T-peak-to-T-end decrease. We confirmed the diagnosis of cirrhotic cardiomyopathy using echocardiography data. Results: Advanced liver disease was associated with prolonged QT intervals. Also, QRS amplitude was lower in patients with decompensated cirrhosis than in patients with compensated liver disease. We found an accentuated deceleration of the T wave in patients with cirrhosis. These findings correlated to serum levels of albumin, cholesterol and ammonia. Conclusions: ECG changes in liver cirrhosis are frequently encountered and are important noninvasive markers for the presence of cirrhotic cardiomyopathy.
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Affiliation(s)
- Letitia Toma
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Adriana Mercan Stanciu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
| | - Anca Zgura
- Chemotherapy Department, OncoFort Hospital, 022328 Bucharest, Romania;
| | - Nicolae Bacalbasa
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Camelia Diaconu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 022328 Bucharest, Romania;
| | - Laura Iliescu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Correspondence: ; Tel.: +407-22-235-695
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