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Novel insights into alcoholic liver disease: Iron overload, iron sensing and hemolysis. J Transl Int Med 2022; 10:92-124. [PMID: 35959455 PMCID: PMC9328032 DOI: 10.2478/jtim-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The liver is the major target organ of continued alcohol consumption at risk and resulting alcoholic liver disease (ALD) is the most common liver disease worldwide. The underlying molecular mechanisms are still poorly understood despite decades of scientific effort limiting our abilities to identify those individuals who are at risk to develop the disease, to develop appropriate screening strategies and, in addition, to develop targeted therapeutic approaches. ALD is predestined for the newly evolving translational medicine, as conventional clinical and health care structures seem to be constrained to fully appreciate this disease. This concept paper aims at summarizing the 15 years translational experience at the Center of Alcohol Research in Heidelberg, namely based on the long-term prospective and detailed characterization of heavy drinkers with mortality data. In addition, novel experimental findings will be presented. A special focus will be the long-known hepatic iron accumulation, the somewhat overlooked role of the hematopoietic system and novel insights into iron sensing and the role of hepcidin. Our preliminary work indicates that enhanced red blood cell (RBC) turnover is critical for survival in ALD patients. RBC turnover is not primarily due to vitamin deficiency but rather to ethanol toxicity directly targeted to erythrocytes but also to the bone marrow stem cell compartment. These novel insights also help to explain long-known aspects of ALD such as mean corpuscular volume of erythrocytes (MCV) and elevated aspartate transaminase (GOT/AST) levels. This work also aims at identifying future projects, naming unresolved observations, and presenting novel hypothetical concepts still requiring future validation.
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Charkoftaki G, Tan WY, Berrios-Carcamo P, Orlicky DJ, Golla JP, Garcia-Milian R, Aalizadeh R, Thomaidis NS, Thompson DC, Vasiliou V. Liver metabolomics identifies bile acid profile changes at early stages of alcoholic liver disease in mice. Chem Biol Interact 2022; 360:109931. [PMID: 35429548 PMCID: PMC9364420 DOI: 10.1016/j.cbi.2022.109931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 12/18/2022]
Abstract
Alcohol consumption is a global healthcare problem with enormous social, economic, and clinical consequences. The liver sustains the earliest and the greatest degree of tissue injury due to chronic alcohol consumption and it has been estimated that alcoholic liver disease (ALD) accounts for almost 50% of all deaths from cirrhosis in the world. In this study, we used a modified Lieber-DeCarli (LD) diet to treat mice with alcohol and simulate chronic alcohol drinking. Using an untargeted metabolomics approach, our aim was to identify the various metabolites and pathways that are altered in the early stages of ALD. Histopathology showed minimal changes in the liver after 6 weeks of alcohol consumption. However, untargeted metabolomics analyses identified 304 metabolic features that were either up- or down-regulated in the livers of ethanol-consuming mice. Pathway analysis revealed significant alcohol-induced alterations, the most significant of which was in the FXR/RXR activation pathway. Targeted metabolomics focusing on bile acid biosynthesis showed elevated taurine-conjugated cholic acid compounds in ethanol-consuming mice. In summary, we showed that the changes in the liver metabolome manifest very early in the development of ALD, and when minimal changes in liver histopathology have occurred. Although alterations in biochemical pathways indicate a complex pathology in the very early stages of alcohol consumption, bile acid changes may serve as biomarkers of the early onset of ALD.
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Affiliation(s)
- Georgia Charkoftaki
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Wan Ying Tan
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Pablo Berrios-Carcamo
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Regenerative Medicine, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago 7610658, Chile
| | - David J Orlicky
- Department of Pathology, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, USA
| | - Jaya Prakash Golla
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Rolando Garcia-Milian
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA; Bioinformatics Support Program, Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, CT, 06210, USA
| | - Reza Aalizadeh
- Laboratory of Analytical Chemistry, Department of Chemistry, National Kapodistrian University of Athens University Campus, Zografou, 15771, Athens, Greece
| | - Nikolaos S Thomaidis
- Laboratory of Analytical Chemistry, Department of Chemistry, National Kapodistrian University of Athens University Campus, Zografou, 15771, Athens, Greece
| | - David C Thompson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
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Krag A, Roskams T, Pinzani M, Mueller S. Diagnostic challenges in patients with alcohol-related liver disease. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:45-57. [PMID: 35042253 DOI: 10.1055/a-1713-4372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Alcohol is globally the leading risk factor for cirrhosis and is subsumed under the term alcohol-related liver disease (ALD). However, only ca. 10% of people with harmful alcohol consumption (>40 gram alcohol per day) develop cirrhosis, while 15% have normal liver histology. Unfortunately, laboratory parameters and ultrasound hold little value to neither rule-in nor rule out alcohol related liver fibrosis. While several indices with combinations of liver associated markers such as FIB4 seem to be promising, non-invasive test strategies are urgently needed with cut-off's that can be applied to guide clinical decision making. The aims of this review article are to highlight novel developments for the diagnosis of ALD and to identify topics of controversy and potential future directions. In the last 15 years, elastography to measure liver stiffness (LS) has significantly improved our screening strategies for cirrhosis. LS values below 6 kPa are considered as normal and exclude ALD. LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. Especially, transient elastography (TE) has been assessed in numerous studies, but similar performance can be obtained with point shear wave elastography, 2 SD shear wave elastography or MR elastography. Important confounders of elevated LS such as inflammation should also be considered and alcohol withdrawal not only improves liver inflammation but also LS. Liver stiffness measurement has signficiantly improved early diagnosis and follow-up of fibrosis in patients with ALD and patients with diagnosed manifest but clinically compensated cirrhosis should undergo further clinical examinations to rule out complications of portal hypertension. In addition, surveillance for the occurrence of hepatocellular carcinoma is recommended in all cirrhotic patients.
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Affiliation(s)
- Aleksander Krag
- Centre for Liver Research/Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tania Roskams
- Department of Imaging and Pathology, University of Leuven, Leuven, Netherlands
| | - Massimo Pinzani
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Sebastian Mueller
- Centre of Alcohol Research, University of Heidelberg, Heidelberg, Germany.,Department of Medicine, Salem KH, Heidelberg, Germany
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4
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Koo S, Sharp L, Hull M, Rushton S, Neilson LJ, McPherson S, Rees CJ. Uncovering undiagnosed liver disease: prevalence and opportunity for intervention in a population attending colonoscopy. BMJ Open Gastroenterol 2021; 8:e000638. [PMID: 34011624 PMCID: PMC8137239 DOI: 10.1136/bmjgast-2021-000638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Due to high rates of obesity and alcohol consumption, the prevalence of fatty liver disease is increasing. There is no widely adopted approach to proactively screen for liver disease in the community. We aimed to assess the burden of potentially undiagnosed liver disease in individuals attending for colonoscopy to develop a pathway to identify and manage individuals with undiagnosed liver disease. DESIGN The OSCAR Study was a cross-sectional study recruiting patients attending for colonoscopy. Patients' metabolic and liver risk factors were measured. The prevalence of undiagnosed significant fatty liver disease was measured using the Fatty Liver Index (FLI) and Fibrosis-4 score (FIB-4). RESULTS 1429 patients (mean age 59±14 years; 48.8% men) were recruited. 73.3% were overweight/obese, 12.7% had diabetes and 17.9% had metabolic syndrome. 19% were consuming more than recommenced alcohol levels (<14 units/week) and 41% had an AUDIT-C score ≥5. After excluding those with known liver disease, 43.2% of the cohort had a high FLI (high likelihood of fatty liver). 5.3% of these had a high FIB-4 score (>2.67, high probability of advanced fibrosis) and 90% of these were previously undiagnosed. 818 patients had a predicted 10-year cardiovascular event risk of ≥10%, however only 377 (46.1%) were on statin therapy. CONCLUSION High levels of obesity, metabolic dysfunction and undiagnosed fatty liver disease were found in individuals attending for colonoscopy. Clinical encounters in the endoscopy unit may represent an opportunity to risk assess for liver and metabolic disease and provide an environment to develop targeted interventions.
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Affiliation(s)
- Sara Koo
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Hull
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Steven Rushton
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Stuart McPherson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdon
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
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5
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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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Lyra AC, de Almeida LMC, Mise YF, Cavalcante LN. Epidemiological profile of alcoholic liver disease hospital admissions in a Latin American country over a 10-year period. World J Hepatol 2020; 12:230-238. [PMID: 32547690 PMCID: PMC7280861 DOI: 10.4254/wjh.v12.i5.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/29/2020] [Accepted: 04/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide.
AIM To describe the epidemiological profile and mortality rates of patients with ALD admitted to public hospitals in different regions of Brazil from 2006 to 2015.
METHODS This is a descriptive study that evaluated aggregate data from the five Brazilian geographic regions.
RESULTS A total of 160093 public hospitalizations for ALD were registered. There was a 34.07% increase in the total number of admissions over 10 years, from 12879 in 2006 to 17267 in 2015. The region with the highest proportion (49.01%) of ALD hospitalizations was Southeast (n = 78463). The North region had the lowest absolute number of patients throughout the study period, corresponding to 3.9% of the total (n = 6242). There was a 24.72% increase in the total number of ALD deaths between 2006 and 2015. We found that the age group between 50 and 59 years had the highest proportion of both hospitalizations and deaths: 28.94% (n = 46329) of total hospital admissions and 29.43% (n = 28864) of all deaths. Men were more frequently hospitalized than women and had the highest proportions of deaths in all regions. Mortality coefficient rates increased over the years, and simple linear regression analysis indicated a statistically significant upward trend in this mortality (R² = 0.744).
CONCLUSION Our study provides a landscape of the epidemiological profile of public hospital admissions due to ALD in Brazil. We detected an increase in the total number of admissions and deaths due to ALD over 10 years.
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Affiliation(s)
- Andre Castro Lyra
- Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia 41253-190, Brazil
- Gastro-Hepatology Service, Hospital Universitario Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia 40301-155, Brazil
| | | | - Yukari Figueroa Mise
- Instituto de Saúde Coletiva-Federal University of Bahia, Salvador, Bahia 40110-040, Brazil
| | - Lourianne Nascimento Cavalcante
- Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia 41253-190, Brazil
- Gastro-Hepatology Service, Hospital Universitario Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia 40301-155, Brazil
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7
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Bhandari R, Khaliq K, Ravat V, Kaur P, Patel RS. Chronic Alcoholic Liver Disease and Mortality Risk in Spontaneous Bacterial Peritonitis: Analysis of 6,530 Hospitalizations. Cureus 2020; 12:e8189. [PMID: 32566430 PMCID: PMC7301415 DOI: 10.7759/cureus.8189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Our study aimed to assess the risk of in-hospital mortality due to chronic alcoholic liver disease (CALD) and other comorbidities in spontaneous bacterial peritonitis (SBP) inpatients. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012 to 2014) from the United States and included 6,530 patients (age 18-50 years) with a primary diagnosis of SBP. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in SBP by comorbidities. Results The prevalence of CALD in SBP patients is 43.6%, and a higher proportion were males (68.8%) and whites (67%). Middle-aged adults (OR 2.8, 95% CI 1.74-4.45) had higher odds of in-hospital mortality in SBP patients. Race and sex were non-significant predictors for mortality risk. Patients with comorbid coagulopathy (OR 1.9, 95% CI 1.45-2.48) and heart failure (OR 3.9, 95% CI 2.46-6.36) have increased mortality in SBP inpatients. After controlling confounders, CALD was significantly associated with increased in-hospital mortality (OR 1.5, 95% CI 1.12-1.94) in SBP inpatients. Conclusion CALD is an independent factor in increasing the risk of in-hospital mortality in SBP patients by 48%. Alcohol use screening, and alcohol abstinence and supportive therapy need to be implemented at an earlier stage to improve health-related quality of life and reduce in-hospital mortality in SBP patients.
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Affiliation(s)
- Renu Bhandari
- Medicine, Manipal College of Medical Sciences, Kaski, NPL
| | - Khalida Khaliq
- Psychiatry/Medicine, North Tampa Behavioral Health, Tampa, USA
| | | | - Pawandeep Kaur
- Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
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8
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Hadefi A, Degré D, Trépo E, Moreno C. Noninvasive diagnosis in alcohol-related liver disease. Health Sci Rep 2020; 3:e146. [PMID: 32166191 PMCID: PMC7060960 DOI: 10.1002/hsr2.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Alcohol‐related liver disease (ALD) represents a major cause of death worldwide, and unfortunately, most patients are diagnosed at an advanced stage of the disease, which is related to poorer outcomes. Liver biopsy has historically been the gold standard for identifying advanced hepatic fibrosis, but this approach has several limitations, including invasiveness, low applicability, sampling variability, and cost. Main Text In order to detect earlier features of advanced liver fibrosis, surrogate biomarkers and techniques have been developed. While these were initially developed for chronic liver diseases such as viral hepatitis and nonalcoholic fatty liver disease (NAFLD), their performance in ALD has also been recently studied. Among the noninvasive surrogate markers and techniques used to detect liver fibrosis, the Enhanced Liver Fibrosis test, FibroTest, and Transient Elastography are the most accurate and validated techniques. In this review, we summarize the current status of the noninvasive assessment of liver disease in ALD and provide a synthesis of how these noninvasive tools can be used in clinical practice. Finally, we briefly outline novel biomarkers that are currently being investigated and discuss future directions and new opportunities in the noninvasive diagnosis of ALD.
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Affiliation(s)
- Alia Hadefi
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology CUB Hôpital Erasme, Université Libre de Bruxelles Brussels Belgium.,Laboratory of Experimental Gastroenterology Université Libre de Bruxelles Brussels Belgium
| | - Delphine Degré
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology CUB Hôpital Erasme, Université Libre de Bruxelles Brussels Belgium.,Laboratory of Experimental Gastroenterology Université Libre de Bruxelles Brussels Belgium
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology CUB Hôpital Erasme, Université Libre de Bruxelles Brussels Belgium.,Laboratory of Experimental Gastroenterology Université Libre de Bruxelles Brussels Belgium
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology CUB Hôpital Erasme, Université Libre de Bruxelles Brussels Belgium.,Laboratory of Experimental Gastroenterology Université Libre de Bruxelles Brussels Belgium
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Moreno C, Mueller S, Szabo G. Non-invasive diagnosis and biomarkers in alcohol-related liver disease. J Hepatol 2019; 70:273-283. [PMID: 30658728 DOI: 10.1016/j.jhep.2018.11.025] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
Abstract
Even though alcohol-related liver disease (ALD) is a major cause of severe liver disease worldwide, most patients with ALD are diagnosed at the decompensation stage. Liver biopsy is still considered the gold standard for establishing a definite diagnosis and assessing the fibrosis stage of ALD, but it is an invasive procedure, associated with significant morbidity. During the last decade, non-invasive tests have been developed to estimate the severity of liver fibrosis and steatosis. Measurement of liver stiffness by transient elastography has become the most commonly used non-invasive parameter to evaluate fibrosis. In ALD, transient elastography has been demonstrated to have an excellent performance to detect advanced fibrosis and cirrhosis. However, aspartate aminotransferase levels must be considered when interpreting liver stiffness cut-offs. Non-invasive biological tests have also been evaluated to assess liver fibrosis in ALD. The commercially available Enhanced Liver Fibrosis test and FibroTest have comparable performance for the diagnosis of advanced fibrosis in ALD, with studies suggesting that they are better than other biological tests (i.e. FIB-4 and APRI). Although ultrasound is still accepted as an initial screen for fatty liver diagnosis, new methods have recently been developed to detect steatosis. Magnetic resonance spectroscopy and magnetic resonance imaging techniques are highly accurate and reproducible, with superior sensitivities and specificities for detecting histological steatosis than ultrasound. However, low availability and high cost limit the use of magnetic resonance techniques in routine clinical practice. More recently, controlled attenuation parameter was developed as a novel tool to non-invasively assess liver steatosis; performed in combination with transient elastography, it was suggested to be superior to regular ultrasound for detecting steatosis and was shown to have acceptable diagnostic accuracy. New serum biomarkers are under investigation to non-invasively diagnose more severe forms of ALD and to predict prognosis of patients.
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Affiliation(s)
- Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Zeppelinstraße 11-33, 69121 Heidelberg, Germany
| | - Gyongyi Szabo
- Department of Medicine, LRB-208, University of Massachusetts Medical School, 364 Plantation Street, Worcester, MA 01605, USA
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Epidemiology of Alcohol Consumption and Societal Burden of Alcoholism and Alcoholic Liver Disease. Clin Liver Dis 2019; 23:39-50. [PMID: 30454831 DOI: 10.1016/j.cld.2018.09.011] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Alcohol abuse is a major determinant of public health outcomes. Worldwide data from 2016 indicate that alcohol is the seventh leading risk factor in terms of disability-adjusted life years, an increase of more than 25% from 1990 to 2016. Understanding the epidemiology of alcoholic liver disease, including the regional variations in consumption and public policy, is an area of active research. In countries where the per capita consumption of alcohol decreases, there appears to be an associated decrease in disease burden. Given alcohol's health burden, an increased focus on alcohol control policies is needed.
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11
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EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69:154-181. [PMID: 29628280 DOI: 10.1016/j.jhep.2018.03.018] [Citation(s) in RCA: 477] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
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12
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Trends in alcohol-related admissions to hospital by age, sex and socioeconomic deprivation in England, 2002/03 to 2013/14. BMC Public Health 2017; 17:412. [PMID: 28482876 PMCID: PMC5423017 DOI: 10.1186/s12889-017-4265-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 04/12/2017] [Indexed: 02/04/2023] Open
Abstract
Background Prevalence of alcohol-related harms in England are among the highest in Europe and represents an important policy issue. Understanding how alcohol-related trends vary by demographic factors is important for informing policy debates. The aim of our study was to examine trends in alcohol-related admissions to hospital in England, with a focus on variations by sex, age and socioeconomic deprivation. Methods We used data on hospital admissions for England for the financial years 2002/03 to 2013/14. Our four main outcome variables were acute and chronic conditions wholly and partially attributable to alcohol consumption. We also looked at four specific conditions wholly attributable to alcohol. Socioeconomic deprivation was measured using the English Indices of Deprivation of a patient’s residence (categorised by quintile). We calculated crude rates, age-specific rates (visualised by Lexis plots) and directly standardised rates by deprivation category, separately for males and females. Results Total admissions for all alcohol-attributable admissions increased from 201,398 in 2002/03 to 303,716 in 2013/14. The relative increase of these admissions was larger than compared to non-alcohol attributable admissions. Acute admissions wholly attributable to alcohol had the largest relative increase of our outcome measures, and displayed a bimodal distribution with higher rates in adolescence/young adults and middle age. Chronic conditions wholly attributable to alcohol were concentrated in middle age (particularly males). While admission rates were generally higher for males, females had higher rates of hospitalisations due to ‘Intentional self-poisoning due to alcohol’. We also found evidence of wide social inequalities by level of deprivation, which were wider for men than compared to women across all of our outcome measures other than ‘Intentional self-poisoning due to alcohol’. Conclusions Our study expands the evidence base to help understand population level trends in alcohol-related admissions by age, sex and socioeconomic deprivation. There have been increasing hospital admissions attributable to alcohol between 2002/03 and 2013/14, particularly concentrated in middle aged males and deprived areas. However, the increase in young females being admitted for ‘Intentional self-poisoning due to alcohol’ raises additional concerns. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4265-0) contains supplementary material, which is available to authorized users.
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13
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Goh ET, Morgan MY. Review article: pharmacotherapy for alcohol dependence - the why, the what and the wherefore. Aliment Pharmacol Ther 2017; 45:865-882. [PMID: 28220511 DOI: 10.1111/apt.13965] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 11/29/2016] [Accepted: 01/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of drinking behaviour, is abstinence from alcohol. Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended. AIM To provide an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence. In addition, factors predictive of therapeutic outcome, including compliance and pharmacogenetics, and the current barriers to treatment, including doctors' unwillingness to prescribe these agents, will be explored. METHODS Relevant papers were selected for review following extensive, language- and date-unrestricted, electronic and manual searches of the literature. RESULTS Acamprosate and naltrexone have a substantial evidence base for overall efficacy, safety and cost-effectiveness while the risks associated with the use of disulfiram are well-known and can be minimised with appropriate patient selection and supervision. Acamprosate can be used safely in patients with liver disease and in those with comorbid mental health issues and co-occurring drug-related problems. A number of other agents are being investigated for potential use for this indication including: baclofen, topiramate and metadoxine. CONCLUSION Pharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilised. Concerted efforts must be made to remove the barriers to treatment in order to optimise the management of people with this condition.
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Affiliation(s)
- E T Goh
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - M Y Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK
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14
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Tan P, Liang H, Nie J, Diao Y, He Q, Hou B, Zhao T, Huang H, Li Y, Gao X, Zhou L, Liu Y. Establishment of an alcoholic fatty liver disease model in mice. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:61-68. [PMID: 27739874 DOI: 10.1080/00952990.2016.1217539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcoholic fatty liver disease (AFLD) defines an important stage in the progression of alcoholic liver disease (ALD), which is a major cause of morbidity and mortality worldwide. OBJECTIVE To establish a mouse model of AFLD. METHODS Male C57BL/6 mice were divided into the following two groups: (i) a control group, which was allowed free access to food and water and (ii) an alcohol-treated group, which was administered a 15% (v/v) alcohol solution instead of water. After 8-9 months of treatment, serum biochemical indexes, histopathological changes, liver triglyceride content, iron storage, and ferritin light chain protein expression were measured using an automatic biochemical analyzer, hematoxylin-eosin (HE) staining, a commercially available kit, Prussian blue staining, and Western blot analysis, respectively. RESULTS Compared with the control group, the alcohol-treated group displayed increased levels of serum LDH, ALT, and AST, decreased levels of ALB, and no significant change in levels of TP. Additionally, increased levels of serum TG, T-CHO, and LDL and decreased levels of serum GLU and HDL were observed in the alcohol-treated mice. HE staining showed that lipid vacuolization occurred in the livers of alcohol-treated mice. The alcohol-treated mice also exhibited increased liver triglyceride content. Moreover, Prussian blue staining and Western blot analysis demonstrated that chronic alcohol administration caused iron overloading of the liver. CONCLUSIONS Chronic administration of 15% (v/v) alcohol in the drinking water over 8-9 months caused AFLD in mice. Our results establish an AFLD model that represents a promising tool for the future study of the progression of ALD.
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Affiliation(s)
- Peizhu Tan
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Huan Liang
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China.,c Department of Clinical Laboratory , Harbin Medical University Cancer Hospital , Harbin , China
| | - Junhui Nie
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Yan Diao
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Qi He
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Baoyu Hou
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Tingting Zhao
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Hui Huang
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Yanze Li
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Xu Gao
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Lingyun Zhou
- a Department of Biochemistry and Molecular Biology , Harbin Medical University , Harbin , China.,b Translational Medicine Center of Northern China , Harbin , China
| | - Ying Liu
- d Department of Gastroenterology , Heilongjiang Province Hospital , Harbin , China
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15
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Litten RZ. Nociceptin Receptor as a Target to Treat Alcohol Use Disorder: Challenges in Advancing Medications Development. Alcohol Clin Exp Res 2016; 40:2299-2304. [DOI: 10.1111/acer.13222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Raye Z. Litten
- Division of Medications Development; National Institute on Alcohol Abuse and Alcoholism (NIAAA); Bethesda Maryland
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16
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Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol 2016; 65:618-30. [PMID: 27155530 DOI: 10.1016/j.jhep.2016.04.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 12/18/2022]
Abstract
Alcohol use disorders (AUDs) is one of the leading causes of disease and disability in almost all European countries. Among the alcohol-related diseases, alcoholic liver disease (ALD) is the most common. At present, alcohol is the most frequent cause of liver cirrhosis in the Western world. The cornerstone of treatment for ALD is achieving total alcohol abstinence and preventing relapse; medical and surgical treatments for ALD are limited when drinking continues. This narrative review summarizes current treatments for AUDs with a particular emphasis to the treatment of AUDs in patients with ALD. Medical management, psychosocial and pharmacological interventions are analyzed, underlying limits and options in AUD patients. Finally, this review discusses the most appropriate setting for the management of AUD patients with advanced liver disease as well as the indications for liver transplantation in AUD patients.
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Affiliation(s)
- Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy; Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Pablo Barrio
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
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