Showing posts with label alcohol consumption. Show all posts
Showing posts with label alcohol consumption. Show all posts

Thursday, June 21, 2018

60,000 adults in the UK have cirrhosis, nearly 75% percent don't know it


7 in 10 people with liver disease in the UK don’t even know they have it 
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

The British Liver Trust’s Love Your Liver campaign focuses on three simple steps to Love Your Liver back to health:

- Drink within recommended limits and have three consecutive alcohol-free days every week
- Cut down on sugar, carbohydrates and fat and take more exercise
- Know the risk factors for viral hepatitis and get tested or vaccinated if at risk

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Tuesday, May 22, 2018

More patients with severe alcoholic hepatitis receiving liver transplants

More patients with severe alcoholic hepatitis receiving liver transplants
Medical centers willing to perform transplants without mandated six-month wait

Washington, DC (May 22, 2018) -- Increasingly, liver transplant centers are changing a long-standing practice of delaying potentially life-saving liver transplantation for patients with severe alcoholic hepatitis until after they stopped drinking alcohol for six months, according to a new study scheduled for presentation at Digestive Disease Week® (DDW) 2018.

Study implications
"Liver transplant for severe alcoholic hepatitis is being increasingly accepted, with positive outcomes, and the hope is that more and more patients will be evaluated for transplants," said Saroja Bangaru, MD, chief resident in internal medicine at the University of Texas Southwestern Medical Center, Dallas, and co-author of the study. "The hope is that survival rates are encouraging enough for centers, so that even more of them will reverse past practices."

Severe alcoholic hepatitis has an extremely high mortality rate. The primary treatment option has been the use of steroids, predominantly prednisolone. But, many patients do not respond to steroids, and a significant percentage of them will die within three months.

Historically, centers would not perform transplants until patients had stopped drinking for six months due to concerns about a return to drinking after transplant. Additionally, there was a perceived high risk that patient's continued drinking would cause them to miss medical appointments and failure to take their immunosuppressant medications, which prevent organ rejection, all of which could contribute to transplant failure.

Only in recent years have limited studies begun to show greater success for transplants for severe alcoholic hepatitis, Bangaru said. These studies have also shown that a variety of other factors -- aside from recent drinking -- influence whether a patient relapses. These include whether the patient has good social support, suffers from psychiatric ailments and accepts that they have an alcohol problem. "These studies suggest that predicting risk of relapse is much more complicated than just duration of abstinence," Bangaru said.

Study design and results
Researchers gathered data from 45 transplant centers, of which 23 said they were now performing such transplants. Among those, 17 centers reported that patients had a one-year survival rate of more than 90 percent, which is higher than that reported in several previous studies.

The survey found that centers have become more willing to perform transplants, as long as patients are carefully screened. Researchers reported that centers use highly selective criteria in approving candidates for transplant, assessing their medical history, social support system and whether they have additional health problems, particularly psychiatric disorders.

"If patients are selected well, according to these criteria, it allows for the excellent survival that we are seeing post-transplant," Bangaru said. Past policy has done a disservice to those patients who were previously unaware that they had liver disease. "Some patients come in for the first time with severe alcoholic hepatitis, and no one has ever told them to stop drinking. Because they are not eligible for transplant, they have a really high mortality rate."

The survey also concluded that most transplant centers had "inadequate" post-transplant support for patients. While most offered the services of social workers, only a limited number provided psychiatric or group therapy support that could be very important in helping patients avoid relapse and further medical problems.

Next steps
Dr. Bangaru said further study is needed to encourage more transplants, in particular a controlled clinical trial that follows survival rates over one, three and five years, along with an assessment of rates of alcoholic relapse.

DDW presentation details
Dr. Saroja Bangaru will present data from the study, "Increased use of liver transplantation as therapeutic option for severe alcoholic hepatitis," abstract Sa1457, on Saturday, June 2, at noon EDT. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place June 2-5 at the Walter E. Washington Convention Center in Washington, DC. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. 
More information can be found at http://www.ddw.org.
https://www.eurekalert.org/pub_releases/2018-05/ddw-mpw051818.php

Monday, May 7, 2018

Study: Alcohol-related cirrhosis patients are sicker, costlier and often female

Michigan Medicine - University of Michigan

Study: Alcohol-related cirrhosis patients are sicker, costlier and often female
A new review of private insurance data finds that alcohol is a major contributor to cirrhosis cases — and that women drinkers are disproportionately affected.

More than one-third of cirrhosis cases are related to alcohol, a seven-year national study of more than 100 million privately insured people has found.

Among that group, 294,215 people had cirrhosis; 105,871 (36 percent) had alcohol-related cirrhosis. The latter group was sicker and admitted or readmitted to a hospital more often, incurring nearly twice the health care costs per person: $44,835 versus $23,329.

“When I look at this data, it tells me that this is a big problem,” says Jessica Mellinger, M.D., a Michigan Medicine gastroenterologist and health services researcher at the Institute for Healthcare Policy & Innovation.

And it could be a particularly big problem for women, who in recent years have been diagnosed with alcohol use disorders at a rate nearly twice that of men.

Mellinger’s study, published in the journal Hepatology, found that women showed a 50 percent increase in alcohol-related cirrhosis during that seven-year period; men showed a 30 percent increase.

Although biology doesn’t explain why women appear to be consuming more alcohol then they used to, it does shed light on the effects.

“Women process alcohol differently than men and they are more susceptible to damage in the liver than men,” says Mellinger. “They can develop cirrhosis with less alcohol and in a shorter time frame. The hypothesis is that certain hormones make women more susceptible, though we don’t know exactly why they are so much more susceptible.”

"Women process alcohol differently than men and they are more susceptible to damage in the liver than men. They can develop cirrhosis with less alcohol and in a shorter time frame."
Jessica Mellinger M.D.

A costly, widespread issue 
To conduct their study, Mellinger and her team examined privately insured individuals ages 18 to 64 by using the Truven MarketScan Commercial Claims and Encounters database. It is the largest dataset of claims for people with private insurance obtained through their employers.

The study’s goal was to determine the prevalence, health-care utilization and costs of alcohol-related cirrhosis among privately insured people in the United States. The research showed:

Patients with alcohol-related cirrhosis aren’t uncommon. The figures nearly surpass those of some common cancers.

Health care for these patients is costly, sometimes as much as the cost for cancer patients.

Cirrhosis has already progressed when many patients see a doctor for symptoms, preventing a chance for early diagnosis and treatment.

But it only looked at one segment of the population.

“At the time we did this study, we also considered using data sets from Medicare and Medicaid, but they were restricting reporting of claims related to substance abuse, and we knew we’d be missing information,” says Mellinger.

Since that time, the Centers for Medicare and Medicaid Services began reporting substance abuse; that information is now open to researchers. Mellinger expects alcohol-related cirrhosis statistics to increase significantly after that patient data is reviewed.

The reason: “Many people with [alcohol-related cirrhosis] are too sick to remain employed, so more of these patients are insured through government-sponsored insurance such as Medicare and Medicaid,” she says, noting that another limitation of the study was a lack of information about race and ethnic groups.

Alcohol-use treatment programs vital 
Prior research has shown that there is no ethical justification for deprioritizing patients from receiving a transplant because they have alcohol-related liver disease.

SEE ALSO: Risky Bingeing: Women in Appalachia Report Higher Rates of Alcohol Misuse

“But first they will need alcohol cessation treatment before they can be transplanted with success,” says Mellinger. “Alcohol-use treatment is effective and many patients do stop drinking, obtain transplant and do well afterward.”

Although there is stigma to alcohol-related cirrhosis, it is common and it’s not a moral failure, she adds. “Many people in the medical community think that alcohol use is not treatable, but it is. There is a lot of collaboration at U-M to provide the right help for patients with alcohol-related liver disease.”

Getting that help is crucial: When patients have advanced liver disease, the only action that affects whether they live or die is if they stop drinking.

“Once you have cirrhosis, or scar tissue on the liver, it’s permanent,” says Mellinger, who works closely with the University of Michigan psychiatry department and the University of Michigan Addiction Treatment Services. “But even though the damage is still there, your liver function can improve dramatically” if you stop drinking.

Set to embark on further study with all insurance payers, Mellinger hopes her current work will help physicians better understand that alcohol-related cirrhosis is a growing problem that demands attention and resources.

“We’re only touching the tip of the iceberg,” she says. “By demonstrating that alcohol-related cirrhosis is a high-burden health care problem that could be prevented, we hope that it will increase funding for early detection of alcohol use and for greater utilization of alcohol-use treatment programs.”

University of Michigan Addiction Treatment Services offers a broad array of services, including a recovery program for health care workers who battle alcohol and substance addiction. 

Friday, May 4, 2018

Even one drink a day linked to lower life expectancy

Behind The Headlines
People who drink above UK alcohol guidelines 'lose one to two years of life'
April 13 2018
"Just one alcoholic drink a day could shorten your life," reports BBC News. A huge study of almost 600,000 drinkers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank no more than this amount. The results applied equally to women and men.

Reuters Health
Even one drink a day linked to lower life expectancy
May 3, 2018
Lisa Rapaport
(Reuters Health) - Even light drinkers who enjoy a single beer or glass of wine every night may still be more likely to die prematurely than people who drink less, a recent study suggests.

Compared to people who drink less than 100 grams of pure alcohol a week - roughly the equivalent of five to six glasses of wine or beer - those who consume 100 grams to 200 grams of alcohol weekly have an estimated life expectancy at age 40 that’s about six months shorter, the study found.

Study
Published in April online in The Lancet

Saturday, April 14, 2018

Behind the Headlines - People who drink above UK alcohol guidelines 'lose one to two years of life'

What is Behind the Headlines?
Each day the NHS Choices team selects health stories that are making headlines. These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information. Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

People who drink above UK alcohol guidelines 'lose one to two years of life'
Friday April 13 2018
"Just one alcoholic drink a day could shorten your life," reports BBC News.

A huge study of almost 600,000 drinkers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank no more than this amount. The results applied equally to women and men.

The current UK guidelines advise limiting alcohol intake to 14 units a week for women and men. This is equivalent to drinking no more than 6 pints of average-strength beer (4% ABV) or 7 medium-sized glasses of wine (175ml, 12% ABV) a week.

These limits are lower than the levels for many other countries, but this latest study suggests they are about right.

The researchers calculated life would be shortened by an average of 1.3 years for women and 1.6 years for men for people aged 40 who drank above the UK weekly limit in comparison with those drinking below the limit.

The study also looked at the likelihood of having a range of non-fatal, but potentially life-changing, cardiovascular conditions, including heart attacks, heart failure and stroke.

Drinking more alcohol was linked to higher chances of all cardiovascular conditions except heart attacks, where it was linked to a lower chance. However, greater risks from other causes of death outweighed any advantage that might bring.

This high-quality study provides further evidence to support the current UK guidelines advising people to drink no more than 14 units a week. Find out more about calculating units of alcohol.

Where did the story come from?
The study was carried out by a collaboration of 120 researchers worldwide, from regions including Australia, Europe, Japan, the UK and the US. It was funded by the UK Medical Research Council, British Heart Foundation, National Institute for Health Research in the UK, European Union and European Research Council.

It was published in the peer-reviewed medical journal The Lancet on an open-access basis so is free to read online.

The study was covered widely in the UK media, with many outlets reporting variations on the life expectancy that could be lost for every drink or number of drinks consumed.

The Daily Telegraph wrote: "Six glasses of wine a week is too much despite government guidelines suggesting it is a safe limit." While the study did suggest 12.5 units is the threshold above which risks start to rise, the difference in risk between people drinking 12.5 and 14 units was small. There's also no agreed classification for the size of a glass of wine.

As statistics expert Professor David Spiegelhalter explained, the study "estimates that, compared to those who only drink a little, people who drink at the current UK guidelines suffer no overall harm in terms of death rates".

What kind of research was this? 
This was a meta-analysis of individual-level data from 83 prospective cohort studies carried out in 19 countries. This type of research – especially when carried out at this scale and with the care the authors took to ensure their methods were robust – is a good way to summarise the best research we have on a particular subject.

However, the studies analysed were all observational studies, as it wouldn't be ethical to carry out studies where some people were encouraged to drink an unhealthy amount of alcohol. This means we have to be cautious when saying alcohol was the direct cause of the additional deaths, because other confounding factors may have affected the results.

What did the research involve? 
Researchers gathered data from 83 studies, starting between 1964 and 2010, that had information about drinkers who didn't have cardiovascular disease at the start of the study, their level of alcohol consumption and additional health data, and that followed up the participants.

After making adjustments for potential factors that might affect the results – such as age, sex, smoking and physical exercise – they carried out statistical analyses to calculate how different levels of alcohol consumption affected people's risk of:
developing cardiovascular disease
death from any cause

The researchers used a big dataset of life expectancy models to calculate how the relative risks of drinking different amounts of alcohol would affect the life expectancy of people aged 40.

What were the basic results?
Of the 599,912 people in the study, 40,310 died and 39,018 got cardiovascular disease during an average 7.5 years of follow-up. About half of the people in the study reported drinking more than 12.5 units of alcohol a week.

Looking at different levels of alcohol consumption, the researchers found:
people drinking up to 12.5 units of alcohol a week had the lowest risk of death from any cause

above that level, the risk of death rose to a more than 30% increased risk for those drinking more than 37 units a week

each additional 12.5 units of alcohol consumed each week increased the risk of stroke by 14% (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.10 to 1.17)

each additional 12.5 units of alcohol consumed each week decreased the risk of heart attack by 6% (HR 0.94, 95% CI 0.91 to 0.97)

the risk of all other cardiovascular conditions increased with each additional 12.5 units of alcohol consumed

When they applied their figures to life expectancy at age 40, the researchers calculated that compared with people drinking up to 12.5 units a week:
those who drank 12.5 to 25 units a week were likely to live 6 months less
those who drank 25 to 44 units were likely to live 1 to 2 years less
those who drank more than 44 units were likely to live 4 to 5 years less

Looking at UK limits (14 units a week), the researchers said that compared with those who drank within current limits:
men who drank above the limits would lose an average of 1.6 years (95% CI 1.3 to 1.8)
women who drank above the limit would lose an average of 1.3 years (95% CI 1.1 to 1.5)

How did the researchers interpret the results? 
The researchers said their main finding was that the lowest risk for avoiding harm from alcohol was found in people drinking no more than 100g, or 12.5 units, of alcohol a week.

They said their detailed analysis of cardiovascular conditions helped to explain the complex links between drinking alcohol and cardiovascular disease, which increased risk of conditions mainly caused by high blood pressure but slightly decreased risks of heart attacks – possibly because of links between alcohol and cholesterol.

They concluded: "These data support adoption of lower limits of alcohol consumption than are recommended in most current guidelines."

Conclusion
This was an impressive study that analysed a lot of high-quality data. It offers strong evidence to support recommendations that people drink within relatively low alcohol limits, like those recently introduced in the UK.

The work regarding cardiovascular disease and heart attacks is useful and challenges the widespread belief that alcohol reduces the risk of cardiovascular conditions. While that may be true for heart attacks, it's isn't for stroke or other conditions.

The study did have a couple of limitations that are worth noting.

In many of the individual studies included in the meta-analysis, the participants were asked only once about how much alcohol they drank – and people are notoriously bad at accurately reporting their drinking. However, if people in the studies routinely underestimated their alcohol consumption, that would mean the meta-analysis results tend towards underestimating the harm alcohol causes.

And while the researchers did their best to account for a range of factors that could have affected the results, it's always hard to control for those completely.

Overall, the study adds weight to the recommendations that both women and men drink within the UK limits of 14 units of alcohol a week.

Analysis by Bazian
Edited by NHS Choices

Links to the headlines 

Thursday, April 12, 2018

Watch - Liver Congress™ 2018 - First Press Conference HEPAHEALTH Project Report

The International Liver Congress™ 2018 (ILC) - Press Conference 1

First official press conference of The ILC 2018 in Paris, France, chaired by EASL Governing Board member Prof Massimo Pinzani on Wednesday, 11 April 2018.

This press conference highlighted the HEPAHEALTH Project Report.
Twitter #Hepahealth


https://www.youtube.com/watch?v=zPkg2zy1QYo

HEPAHEALTH Project Report -- risk factors and the burden of liver disease in Europe and selected Central Asian countries
11 April 2018, Paris, France: The HEPAHEALTH Project Report, which was presented today in a press conference at The International Liver Congress trade; 2018 in Paris, France, is the second overview commissioned by EASL on the burden of liver disease in Europe. The report encompasses 35 countries in total: the EU region, Iceland, Kazakhstan, Norway, Russia, Serbia, Switzerland and Uzbekistan.

The aims of the report were to: report on the latest epidemiological burden of liver disease in the wider European region; present the data on the main risk factors for liver disease; and, carry out a review of review on public health interventions.

Since EASL published its first overview in 2013, the situation has not improved. In particular, liver cancer mortality has increased and only a few countries have seen a decrease or even a stabilisation in rates since 1980.

The European region is the highest consumer of alcoholic beverages in the world and efforts to reduce alcohol consumption are stalling in many countries. Likewise, rates of obesity have risen across almost every country the report surveyed since 2013 and the rates of Non-Alcoholic Fatty Liver Disease (NAFLD) are increasing accordingly. In Southern and Eastern Europe viral hepatitis is the leading cause of liver disease mortality.

Two key points stand out in the findings of the report: 

Liver disease kills early: Two thirds of all potential years of life lost due to liver disease were working years of life. This contrasts with other diseases, such as stroke, where the majority of deaths occur after the age of 65.

A geographical and income divide: Liver disease mortality has decreased across Western and Central Europe since 1970. Most of the countries with high stable or increasing rates of liver disease are located in the poorer parts of the European Union and the countries of the former Soviet Union. The UK and Finland deviate from the rest of Western European and Nordic trends: Both countries have seen steep increases in liver disease mortality since 1970.

What needs to be done? 

Vaccinations for Hepatitis B virus and screening of blood products across the EU since the early 1990s has helped to drastically reduce the number of HBV infections. Better harm reduction policies and micro-elimination strategies must be implemented across the region if there is to be an impact on Hepatitis C Virus infection rates. -The new generation of direct acting antivirals will largely eliminate cases of HCV provided that governments ensure that all patients who need them have access to treatment.

It is clear that prevention is the key to reducing other liver diseases, particularly for alcohol and obesity related liver disease where effective treatments do not exist or are not very effective. European countries must do more to promote a reduction in alcohol consumption and to reduce levels of obesity. The European Union and its member states used to be a world leader in progressive public health policies: It is time for them to get back in the saddle and save another generation from liver disease.

https://www.eurekalert.org/pub_releases/2018-04/eaft-hpr041218.php

Wednesday, April 11, 2018

EASL Practice Guidelines - Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E

The International Liver Congress 2018

Clinical practice guidelines: Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E Infection

April 11, 2018
The European Association for the Study of the Liver (EASL) just released - Updated EASL Recommendations on Treatment of Hepatitis C 2018 -
*Shared by @HenryEChang via Twitter.

You can view the following publications online in the Journal of Hepatology;
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 10, 2018
Full-Text

EASL Clinical Practice Guidelines: Management of alcohol-related liver disease
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 5, 2018
Full-Text HTML
PDF

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 5, 2018
Full-Text HTML
PDF


EASL Clinical Practice Guidelines on hepatitis E virus infection
European Association for the Study of the Liver
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: March 30, 2018
Full-Text HTML
PDF

Links
Practice Guidelines - Download Slide Decks
EASL Clinical practice guidelines electronic versions
https://ilc-congress.eu/ebooks/#CPGs

Updates - For Patients: The International Liver Congress 2018.
Link to websites offering coverage, meeting highlights, learning activities, and a summary of the meeting. Watch for meeting updates on the sidebar of this blog.

#ILC2018 Alcoholic liver disease replaces hepatitis C infection as leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA

European Association for the Study of the Liver
11 April 2018, Paris, France: Two independent studies have today reported that alcoholic liver disease has now replaced hepatitis C virus (HCV) infection as the leading cause of liver transplantation in the USA in patients without HCC. Non-alcoholic steatohepatitis (NASH) is also on the increase, now ranking second as a cause of liver transplantation due to chronic liver disease.

Chronic HCV infection has remained the leading indication for liver transplantation in the USA for the last two decades.1 However, the availability of second-generation direct-acting antiviral agents (DAAs) in late 2013 led to a decline in the number of HCV-related liver transplant waiting list registrations and surgeries from 2015 onwards.2,3 Alcohol consumption began to increase markedly in the US during the 1990s and early 2000s, with data highlighting dramatic rises in alcohol use and high-risk drinking in recent years.4

The two studies presented this week at The International Liver Congress™ 2018 in Paris, France, were conducted to evaluate recent trends in the aetiology of liver disease among liver transplant recipients in the USA in view of the changing landscape of potential risk factors. In the first study, data from the United Network for Organ Sharing (UNOS) between 2005-2016 were analyzed, looking at four indications for chronic liver disease: alcoholic liver disease (ALD), NASH, HCV infection, and HCV/ALD combined. According to the results of the study, the number of liver transplant recipients with HCV peaked in 2014 (1,905 individuals) and has been declining ever since. In contrast, the number of liver transplants due to ALD and NASH has been steadily increasing and, in 2016, there were 1,624 liver transplants performed as a result of ALD, compared with 1,535 due to HCV, 1,334 due to NASH, and 424 due to HCV/ALD.

'Although we found that, overall, alcoholic liver disease became the leading indication for liver transplantation in the US in 2016, NASH was not far behind', said Dr Jennifer Wang from the California Pacific Medical Center in San Francisco, USA, who presented the study findings. 'Importantly, NASH is now the leading cause of liver transplantation in women, which is not entirely surprising given the higher rates of metabolic syndrome in women and the resultant increased risk of non-alcoholic fatty liver disease'.

'In African Americans and those with hepatocellular carcinoma, HCV remains the leading cause of transplantation and a major burden'.

The second study presented today also evaluated data from the UNOS registry, looking at first liver transplants performed in individuals without HCC between January 2012 and October 2017. As in the first study, HCV infection remained the leading aetiology for liver transplant recipients until 2016, when ALD surpassed it, accounting for 24% of liver transplants performed compared with 19% for NASH and 18% for HCV. In 2017, ALD, NASH, and HCV were responsible for 24%, 18%, and 17% of liver transplants, respectively, according to the results of this study.

'One of our most worrying findings was that patients with ALD are being listed for liver transplantation at a much younger age and with more severe disease than patients with either HCV infection or NASH', said investigator, Dr George Cholankeril from Stanford University Medical Center, California, USA. 'These are very ominous trends and we need to take aggressive action to address these rising rates of liver transplantation in patients with alcoholic liver disease'.

'So far, alcoholic liver disease has received much less attention with regards to clinical and basic research than either hepatitis B or C',5 said Prof. Helena Cortez-Pinto from the University Hospital of Santa Maria, Lisbon, Portugal, and EASL Governing Board Member. 'It is time to change and turn our attention to ALD, both in research and of course in policies that have been shown to reduce consumption, such as increases in taxation, in order to decrease affordability'.

About The International Liver Congress™
This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.

About The European Association for the Study of the Liver (EASL)
Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Onsite location reference
Session title: Poster presentations Time, date and location of session: Poster area (Hall 7.2) Presenters: Jennifer Wang and George Cholankeril, USA Abstracts: Alcoholic liver disease surpasses hepatitis C virus in 2016 to become the leading indication for liver transplantation among adults without hepatocellular carcinoma in the United States (13 April 2018 9:00-17:00) and Alcoholic liver disease replaces HCV infection as the leading indication for liver transplantation in the United States (14 April 09:00-17:00)

Author disclosures
Jennifer Wang: None reported
Robert Gish: Dr. Gish has received Grants/Research Support from AbbVie, Benitec Biopharma, Gilead Sciences, and Merck & Co. Dr. Gish has performed as Consultant and/or Advisor to AbbVie, Akshaya Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Genentech, Gilead Sciences, Hoffman-LaRoche, Ltd., Ionis Pharmaceuticals, Janssen, Merck & Co., Nanogen Biopharmaceutical, and Presidio Pharmaceuticals. Dr. Gish has current activity with the scientific or clinical advisory boards of AbbVie, AstraZeneca, Genentech, Gilead Sciences, Janssen, Merck & Co., and Nanogen Biopharmaceutical. Dr. Gish is a member of the Speakers Bureau for AbbVie, Bristol-Myers Squibb, Gilead Sciences, and Merck. Dr. Gish is a minor stock shareholder of Cocrystal Pharma.

Benny Liu: None reported Taft Bhuket: None reported
Robert Wong: Dr Wong receives research funding from Gilead Sciences and AbbVie, has served as a consultant and member of the advisory board for Gilead Sciences, and serves on the speaker's bureau for Gilead Sciences, Salix, and Bayer. Dr Wong is also funded by an AASLD Foundational Clinical and Translational Research Award in Liver Diseases.

George Cholankeril and co-authors: None reported
References 1. Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2017; doi: 10.1016/j.cgh.2017.11.045 [Epub ahead of print].

2. Goldberg D, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152(5):1090-9.e1.

3. Flemming JA, et al. Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy. Hepatology. 2017;65(3):804-12.

4. Grant BF, et al. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 2017;74(9):911-23.

5. Ndugga, N, et al. Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA. BMJ Open. 2017;7(3):e013620; doi: 10.1136/bmjopen-2016-013620 [Epub ahead of print].

Wednesday, April 4, 2018

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis

This study focused on the impact of a mild drinking habit on liver carcinogenesis in 301 biopsy-proven non-alcoholic fatty liver disease (NAFLD) patients. Multivariate analysis revealed that mild drinking of < 20 g/d might increase the risk of hepatocellular carcinoma in NAFLD patients, particularly those with advanced fibrosis (F3-4). NAFLD patients with severe fibrosis should abstain from even small amounts of regular alcohol consumption.

World J Gastroenterol. Apr 7, 2018; 24(13): 1440-1450
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1440

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis
Takefumi Kimura, Naoki Tanaka, Naoyuki Fujimori, Ayumi Sugiura, Tomoo Yamazaki, Satoru Joshita, Michiharu Komatsu, Takeji Umemura, Akihiro Matsumoto, Eiji Tanaka

AIM
The impact of mild drinking habit (less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease (NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD.

METHODS
A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with non-alcoholic steatohepatitis, 26% with advanced fibrosis (F3-4)] were divided into the mild drinking group with ethanol consumption of less than 20 g/d (mild drinking group, n = 93) and the non-drinking group (n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma (HCC) occurrence were compared between the groups.

RESULTS
We observed significant differences in male prevalence (P = 0.01), platelet count (P = 0.04), and gamma-glutamyl transpeptidase (P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group (6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox’s regression model revealed that hepatic advanced fibrosis (F3-4) (P < 0.01, risk ratio: 11.60), diabetes mellitus (P < 0.01, risk ratio: 89.50), and serum triglyceride (P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal (P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis (F3-4), however, a drinking habit (P = 0.04, risk ratio: 4.83), alpha-fetoprotein (P = 0.01, risk ratio: 1.23), and diabetes mellitus (P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence.

CONCLUSION
A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.

Continue to full article: https://www.wjgnet.com/1007-9327/full/v24/i13/1440.htm

Summary & Commentary
The Effect of Modest Alcohol Use in Patients with Nonalcoholic Steatohepatitis
Atif Zaman, MD, MPH reviewing Ajmera V et al. Clin Gastroenterol Hepatol 2018 Mar 14
Longitudinal data suggest that having 1 or 2 drinks daily worsens liver histology.

Wednesday, March 28, 2018

Liver cancer caused by alcohol consumption may have worse prognosis than other forms

Liver cancer caused by alcohol consumption may have worse prognosis than other forms

A new study indicates that patients with alcohol-related liver cancer often do not live as long as patients with liver cancer that is not associated with alcohol consumption, mainly due to diagnoses at later stages. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings indicate that efforts should be made to improve both screening for early signs of liver cancer and the management of alcohol abuse.

Liver cancer is the second leading cause of cancer-related deaths worldwide, with hepatitis B and C infections being the main causes. Alcohol abuse and non-alcoholic fatty liver disease are other dominant risk factors. Due to improvements in the treatment of hepatitis infections and increased alcohol consumption in some regions, it is likely that alcohol will become a leading cause of liver cancer in the near future. Indeed, alcohol is already the first cause of liver cancer in France and involved in 25 percent to 30 percent of diagnoses in the United States. The real US figure is likely higher as alcohol consumption is often underreported when another risk factor is present.

To compare aspects of alcohol-related and non-alcohol-related liver cancer, Charlotte Costentin, MD, of Hôpital Henri-Mondor in France, and her colleagues examined 894 patients with newly diagnosed liver cancer who were followed for 5 years; 582 patients (65 percent) had a history of chronic alcohol abuse and 312 (35 percent) did not. Investigators also recorded whether patients with alcohol-related liver cancer were abstinent or not at the time of cancer diagnosis.

A total of 601 patients had died by the time of the investigators' final analyses. Alcohol-related liver cancers were more likely to be diffuse and were detected in patients with worse liver function. Median overall survival was 9.7 versus 5.7 months in the non-alcohol-related and alcohol-related groups respectively. When investigators looked at each stage of cancer individually, however, survival was similar in patients with non-alcohol-related and alcohol-related cancer. The findings suggest that patients with alcohol-related liver cancer have a reduced overall survival mainly due to worse liver function and tumor characteristics at diagnosis.

The analysis also examined whether patients were participating in cirrhosis follow-up programs before their cancers were diagnosed. (Most people who develop liver cancer show signs of scarring, or cirrhosis, in the liver, and international guidelines recommend ultrasound every six months to detect early liver cancer in patients with cirrhosis.) Patients whose liver cancer was detected during a cirrhosis follow-up program had improved survival compared with patients whose cancer was diagnosed incidentally. This was especially pronounced in patients with non-alcohol-related liver disease or those with alcohol-related liver disease who are no longer drinking alcohol compared with non-abstinent patients. Also, non-abstinent alcoholic patients had the lowest survival in the study, even when restricting the analysis to patients involved in cirrhosis follow-up programs.

"To improve prognosis of liver cancer in the alcoholic population, efforts should be made to implement effective screening programs for both cirrhosis and liver cancer, and to improve access to alcoholism treatment services," said Dr. Costentin. "A smaller tumor burden and a better liver function at diagnosis should translate into higher rates of patients with alcohol-related liver cancer amenable to curative treatment such as tumor resection or ablation and liver transplantation."


Full Citation: "Hepatocellular carcinoma is diagnosed at a later stage in alcoholic patients: results of a prospective nationwide study." Charlotte E. Costentin, Abbas Mourad, Pierre Lahmek, Xavier Causse, Alexandre Pariente, Hervé Hagège, Anca Stela Dobrin, Claire Becker, Bérangère Marks, Robert Bader, Bertrand Condat, Frédéric Héluwaert, Jean François Seitz, Bruno Lesgourgues, Jacques Denis, Sylvie Deuffic-Burban, Isabelle Rosa, and Thomas Decaens on behalf of CHANGH study group. CANCER; Published Online: March 28, 2018 (DOI: 10.1002/31215).

URL Upon Publication: http://doi.wiley.com/10.1002/31215

Saturday, March 17, 2018

Hep C Compounds Alcoholism’s Effect on Brain Volume

Study
JAMA Psychiatry Published March 14, 2018
Full Text Article: The Role of Aging, Drug Dependence, and Hepatitis C Comorbidity in Alcoholism Cortical Compromise
Findings
This combined cross-sectional/longitudinal study evaluated magnetic resonance imaging data collected during 14 years in 199 control and 222 alcohol-dependent participants. Findings revealed frontally distributed cortical volume deficits in individuals with alcohol dependence, accelerated age-dependent decline, and compounded deficits with drug dependence or hepatitis C virus infection comorbidity.

Meaning
These findings raise concern for heightened risk of accelerated cortical aging with alcohol dependence even when alcohol misuse develops later in life.

In The Media
Hep C Compounds Alcoholism’s Effect on Brain Volume
Last Updated: March 16, 2018.
Media Source - DoctorsLounge

FRIDAY, March 16, 2018 (HealthDay News) -- Alcohol dependence has deleterious effects on frontal cortical volumes that are compounded by hepatitis C virus (HCV) infection and drug dependence, according to a study published online March 14 in JAMA Psychiatry.

Edith V. Sullivan, Ph.D., from the Stanford University School of Medicine in California, and colleagues examined cortical volume deficits using 826 structural magnetic resonance images from 222 individuals with alcohol dependence and 199 age-matched control participants. Longitudinal data were available for 116 participants with alcoholism and 96 controls.

The researchers found that participants with alcohol dependence had volume deficits in frontal, temporal, parietal, cingulate, and insular cortices; the deficits were prominent in fontal subregions and were not dependent on sex. In the frontal cortex and precentral and superior gyri, accelerated aging occurred; this could not be attributed to the amount of alcohol consumed, which was greater in younger- versus older-onset participants with alcoholism. Smaller frontal volumes were seen for alcohol plus cocaine and alcohol plus opiate groups versus drug-dependence-free alcoholism groups. Greater deficits were seen in those with versus those without HCV infection in frontal, precentral, superior, and orbital volumes; in uninfected participants with alcoholism, total frontal, insular, parietal, temporal, and precentral volume deficits persisted compared with control participants with known HCV status.

"We speculate that age-alcohol interactions notable in frontal cortex put older adults at heightened risk for age-associated neurocompromise even if alcohol misuse is initiated later in life," the authors write.

Abstract/Full Text

CDC: US binge drinking responsible for over half of 88,000 alcohol-attributable deaths per year

CDC: US binge drinking responsible for over half of 88,000 alcohol-attributable deaths per year


Binge drinking can result in dangerous driving, risky sexual behavior, and violent behavior. Over time, binge drinking also increases the risk of serious health problems such as cancer, heart disease, and liver failure. Annually, binge drinking is responsible for more than half of the 88,000 alcohol-attributable deaths and three-quarters of the $249 billion in economic costs associated with excessive drinking in the United States.

During binges, U.S. adults have 17 billion drinks a year

More than half of those drinks are by adults ages 35 years and older
U.S. adults consumed more than 17 billion binge drinks in 2015, or about 470 binge drinks per binge drinker, according to a first-of-its-kind study released by the Centers for Disease Control and Prevention (CDC). The study appears in the American Journal of Preventive Medicine.

CDC researchers found that 1 in 6, or 37 million, adults binge drink about once a week, consuming an average of seven drinks per binge. Binge drinking is defined as consuming five or more drinks for men, or four or more drinks for women, in about two hours.

“This study shows that binge drinkers are consuming a huge number of drinks per year, greatly increasing their chances of harming themselves and others,” said study co-author Robert Brewer, M.D., M.S.P.H., lead researcher in CDC’s alcohol program. “The findings also show the importance of taking a comprehensive approach to prevent binge drinking, focusing on reducing both the number of times people binge drink and the amount they drink when they binge.”

For this report, CDC scientists analyzed data on self-reported binge drinking during the past 30 days from CDC’s 2015 Behavioral Risk Factor Surveillance System (BRFSS). Total annual binge drinks was calculated by multiplying the estimated total number of binge drinking episodes among binge drinkers by the average largest number of drinks consumed per episode, and was assessed by age, sex, education, race/ethnicity, household income, and state.

Binge drinking varied by age, sex, and social factors

New insights on binge drinking reported in the study include:
-While the prevalence of binge drinking was more common among young adults ages 18-34 years, more than half of the binge drinks consumed each year were by adults ages 35 years and older. 
-About 4 in 5 total binge drinks were consumed by men.
-Binge drinkers with lower household incomes (less than $25,000 a year) and lower educational levels (less than high school) consumed substantially more binge drinks per year than those with higher incomes and educational levels.
-Binge drinkers consumed the most alcohol in Arkansas, Mississippi, Kentucky, and Hawaii, and the least in Washington, DC; New Jersey, New York, and Washington State.

Binge drinking can result in dangerous driving, risky sexual behavior, and violent behavior. Over time, binge drinking also increases the risk of serious health problems such as cancer, heart disease, and liver failure. Annually, binge drinking is responsible for more than half of the 88,000 alcohol-attributable deaths and three-quarters of the $249 billion in economic costs associated with excessive drinking in the United States.

How to reduce binge drinking
Widespread use of effective community prevention strategies, such as limiting the number of alcohol outlets in a geographic area, limiting days and hours of sale, and legal liability for outlets that illegally serve underage or intoxicated patrons, could help reduce total binge drinks and related harms. The U.S. Preventive Services Task Force also recommends alcohol screening and brief intervention by health care providers as part of routine clinical care.

The U.S. Dietary Guidelines for Americans recommends that if alcohol is consumed, it should be consumed in moderation — up to one drink per day for women and up to two drinks per day for men — and only by adults of legal drinking age.

For more information on excessive alcohol use: www.cdc.gov/alcohol.
https://www.cdc.gov/media/releases/2018/p0316-binge-drinking.html

Thursday, February 22, 2018

Young men's drinking tied to later liver disease risk

Young men's drinking tied to later liver disease risk
Last Updated: 2018-02-22
By Lisa Rapaport (Reuters Health)

Men who drink alcohol in late adolescence are more likely to develop severe liver disease decades later than young people who don't drink at all, a Swedish study suggests.

Researchers examined data on alcohol consumption for 43,296 men entering military service in 1969 and 1970 when they were 18 to 20 years old.

After an average follow-up of almost 38 years, a total of 383 men were diagnosed with severe liver disease, including 208 who died.

Each daily gram of alcohol men typically consumed in their youth was associated with a 2% increase in the risk of severe liver disease, even after researchers accounted for other independent risk factors for liver damage like obesity, smoking and cardiovascular disease.

Continue reading: http://www.chronicliverdisease.org/reuters/article.cfm?article=20180222Other1195795296

Sunday, January 7, 2018

Considering A Dry January? If Not - Let's Talk About Liver Disease

Considering A Dry January? If Not - Let's Talk About Liver Disease
Greetings, will you be changing any bad habits this year? If you consume too much alcohol why not take part in the "Dry January" campaign. Could one month of giving up alcohol improve your heath? Today over at NPR, Dr. Rajiv Jalan, talks about the science behind just that, listen to program, here.

The Effects Of Alcohol On The Body
The benefits of participating in a Dry January may be an effective stepping stone to giving up alcohol completely in the future. If you abuse alcohol consider this, the effect of alcohol on your body begins early on, but long-term use of alcohol can take a serious toll on your liver causing fibrosis, cirrhosis and liver cancer. Rather you drink a little or a lot, alcohol use increases your risk of developing not just liver cancer, but other cancers such as head and neck cancers, colorectal cancer, esophagus and female breast cancers. In addition, people with alcoholic liver disease and cirrhosis die more frequently from decompensation of cirrhosis than patients with cirrhosis related to chronic HCV infection or fatty liver disease, and alcohol-related liver disease has now surpassed HCV as the most common indication for liver transplant in the United States.

HCV & Alcohol 
Numerous studies have demonstrated the progression of liver disease for people with both alcohol abuse and HCV is worse when compared to people with only one disease. Those who have HCV and abuse alcohol show an increased rate of fibrosis and liver cancer, and have a higher rate of early death, compared to people with HCV who do not abuse alcohol. According to a 2016 prospective study published in the Journal of Hepatology drinking even low levels of alcohol is connected with increase risk for liver cancer in people with HCV related cirrhosis;
Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. In this prospective study, light-to-moderate alcohol intake was associated with the risk of hepatocellular carcinoma in multivariate analysis. No patients who did not use alcohol and who reached viral eradication developed hepatocellular carcinoma during follow-up. The risk of hepatocellular carcinoma increased with alcohol intake or in patients without viral eradication and was highest when alcohol intake was present in the absence of viral eradication. Patients with HCV-related cirrhosis should be strongly advised against any alcohol intake. Patient care should include measures to ensure abstinence.
Read a nice summary of the article over at Healio.

In a more recent 2017 review, which explores risk of alcohol use in people with liver diseases other than alcoholic liver disease, that is people with hepatitis C, hepatitis B, fatty liver disease, and autoimmune hepatitis reported; alcohol consumption of more than 30 g per day in men and 20 g per day in women is associated with fibrosis progression, development of cirrhosis and hepatocellular carcinoma, and mortality in most liver diseases, view the article here.

How Do I Know If I Have Liver Disease Related To Alcohol?
In many cases, people who have developed liver disease associated with alcohol abuse just don't have any noticeable symptoms until their liver is badly damaged. 

What Is ALD? 
Alcohol-related liver disease or ALD, is caused by excessive consumption of alcohol overtime, the earliest stage of ALD is fatty liver disease, also called steatosis, and is the most common alcohol-related liver disorder. The next stage is alcoholic hepatitis, in which the liver cells become inflamed, finally alcoholic cirrhosis, develops when normal liver tissue is replaced by nonliving scar tissue.

Whilst many people who consume more than 60 g of alcohol a day (equivalent to half a bottle of wine or more than a litre of beer) will develop steatosis (accumulation of fat in the liver), only a minority will go on to develop the more serious condition of alcoholic liver inflammation (alcoholic hepatitis) and between 10 to 20% will develop cirrhosis (irreversible scarring of the liver). Alcohol consumption is responsible for nearly 5.9% of all deaths globally and 139 million disability-adjusted life-years lost due to premature death from alcohol.
How much Alcohol - Is Too Much?
Watch - All About Alcohol: Dr. Joe Galati
In 2017, Dr. Joe Galati discussed cutting down on alcohol and the importance of knowing the amount of alcohol in various types of alcohol and serving sizes.

The Bottom Line
Remember the best treatment for alcoholic liver disease is to not drink, hopefully your liver isn't too far damaged and can repair itself, prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. As for people with HCV, not drinking is the on the list of the most important thing you can do for your liver. But you already know that. 

Again, HAPPY NEW YEAR!
Tina

Wednesday, November 8, 2017

Cutting back on alcohol can prevent cancers: experts

Cutting back on alcohol can prevent cancers: experts
Last Updated: 2017-11-07

By Cheryl Platzman Weinstock

..alcohol consumption is known to increase the risk of several cancers, including head and neck, esophageal, liver, colorectal and female breast cancers.

(Reuters Health) - A large organization of cancer doctors has issued a call to action to minimize alcohol consumption.

With a newly released position paper, the American Society of Clinical Oncology (ASCO) hopes to draw attention to the strong links between drinking alcohol and risks for several types of cancer.
"People are not aware of this," said Susan Gapstur, a vice-president of the American Cancer Society who was not involved with the position statement.

In a phone interview, Gapstur stressed that people living with cancer remain at risk for other cancers so it's important that they realize alcohol's role in cancer recurrence, too.

The call to action from ASCO follows a survey the group commissioned, which found that 70% of Americans do not recognize drinking alcohol as a risk factor for cancer. In fact, alcohol consumption is known to increase the risk of several cancers, including head and neck, esophageal, liver, colorectal and female breast cancers.

Read more: http://www.chronicliverdisease.org/reuters/article.cfm?article=20171107Other532649162

Friday, October 20, 2017

Liver Meeting® 2017 - Health care costs for treating alcoholic cirrhosis on the rise

Updates On This Blog
The Liver Meeting® 2017

Health care costs for treating alcoholic cirrhosis on the rise
Washington, D.C. – Health care costs for privately insured patients with alcoholic cirrhosis are nearly twice that of non‐alcoholic cirrhosis patients in the United States, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Alcoholic cirrhosis (scarring of the liver due to heavy alcohol use) is a major cause of liver disease and death in the U.S., and worldwide. Rising rates of alcohol‐use disorders are predicted to lead to further increases, and investigators from the University of Michigan recently examined the prevalence, health care utilization and costs for alcoholic cirrhosis.

“My colleagues at Michigan and I began to notice that we were seeing more and more patients in our clinics and in hospital with severe alcoholic liver disease. As a result, we initiated this study to determine if what we were seeing was being found across the nation,” says Jessica Mellinger, MD, clinical lecturer at Michigan Medicine’s Division of Gastroenterology, whose research is supported by a 2016 AASLD Foundation Clinical and Translational Research Award.

Dr. Mellinger’s team collected data spanning 2008 to 2015 on prevalence, admissions and readmissions to health care facilities, and health care costs among people ages 18 to 65 with alcoholic cirrhosis. Yearly prevalence trends for alcoholic and non‐alcoholic cirrhosis were calculated. Using this data, the researchers estimated rates of complications due to portal hypertension (an obstruction of blood flow, and increase of blood pressure, in the liver) and determined the effect alcoholic cirrhosis had on total and per‐person health care costs, as well as admissions and readmissions to hospital.

Among the people studied, nearly 300,000 had cirrhosis in 2015, with 36 percent of these cases attributed to alcohol use. National prevalence of cirrhosis and alcoholic cirrhosis rose from .19 percent to .27 percent between 2008 and 2015 for cirrhosis overall, and .07 percent to .10 percent for alcoholic cirrhosis.

Dr. Mellinger’s team found that patients with alcoholic cirrhosis were significantly more likely to be diagnosed long after liver deterioration had already begun, and more likely to be admitted and readmitted within 30 days. Per‐person health care costs in the first year after diagnosis were nearly double for these patients compared to patients without alcoholic cirrhosis, and direct health care costs for alcoholic cirrhosis totaled around $5 billion, making up just over half the total costs of all‐cause cirrhosis.

Dr. Mellinger plans to use this research to further explore how many alcoholic cirrhosis patients gain access to alcohol use disorder treatment and who benefits from treatment. “Because alcohol cessation is the only proven therapy that can improve outcomes in patients with alcoholic cirrhosis, we hope to find ways to help these patients stop drinking by helping them connect with alcohol use disorder treatment,” explains Dr. Mellinger, who also notes the importance of early diagnosis and alcohol cessation to help improve outcomes in these patients.

Dr. Mellinger will present these findings at AASLD’s press conference in Room 103B at the Walter E. Washington Convention Center in Washington, D.C. on Saturday, October 21 at 4 PM. Dr. Mellinger will present the study entitled “The Rising Healthcare Burden of Alcoholic Cirrhosis in the United States” on Monday, October 23 at 10 AM in room 151. The corresponding abstract (169) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

Friday, September 8, 2017

Drinks industry distorts alcohol cancer risk

Drinks industry distorts alcohol cancer risk
Last Updated: 2017-09-07

By Kate Kelland
LONDON (Reuters) - The alcohol industry uses denial, distortion and distraction to mislead people about the risks of developing cancer from drinking, often employing similar tactics to those of the tobacco industry, a study said on Thursday.

Drinks industry organizations often present the relationship between alcohol and cancer as highly complex, implying there is no clear evidence of a consistent link, said the study led by scientists at the London School of Hygiene and Tropical Medicine (LSHTM) and Sweden's Karolinska Institute. The article was published online September 7 in Drug and Alcohol Review.

Other strategies include denying any relationship exists, or saying inaccurately that there is no risk with moderate drinking, the study found. The industry also seeks to mention a wide range of other real and potential cancer risk factors in an effort to present alcohol as just one of many, it added.

Responding to the study, the Distilled Spirits Council, a U.S. alcohol trade association, said it was "a highly selective" review authored by researchers with "anti-alcohol biases."

"The Council does not recommend that people drink alcohol for potential health benefits," it said in a statement. "Drinking in moderation may pose health risks for some people, and some individuals should not drink at all."

The International Alliance for Responsible Drinking, which represents large brewers and distillers including Anheuser-Busch InBev and Diageo, said it disagreed with the study's conclusions. "We . . . stand by the information that we publish on drinking and health," it said.

RISING RISK
The World Health Organization says drinking alcohol is a well-established risk factor for a range of cancers, including tumours of the mouth, liver, breast and colon and bowel. And the risk of cancer rises with levels of alcohol consumed.

The research team behind Thursday's study analyzed the information relating to cancer on the websites and documents of nearly 30 alcohol industry organizations around the world between September 2016 and December 2016.

"The weight of scientific evidence is clear - drinking alcohol increases the risk of some of the most common forms of cancer," said Mark Petticrew, a professor of public Health at the LSHTM who co-led the study.

"It has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry. Our analysis suggests that the major global alcohol producers may attempt to mitigate this by disseminating misleading information."

Petticrew's team identified three main industry strategies: Denying any link with cancer, or selective omission of the relationship; distortion by mentioning some risk of cancer, but misrepresenting or obfuscating its size; and distraction by seeking to draw focus away from the risks of alcohol and towards other cancer risks.

One of the most significant findings was that industry materials omitted or misrepresented evidence on breast and bowel cancer, both of which are linked to drinking. When breast cancer was mentioned, 21 of the organizations studied gave no, or misleading, information about it, the study said.

Ian Gilmore, chair of the Alcohol Health Alliance UK, said the study "clearly shows the alcohol industry misleading the public."

"With only 1 in 10 people aware of the link between alcohol and cancer, people have both a need and a right to clear information about the health risks of drinking alcohol."

Petticrew said the study's findings, published in the journal Drug and Alcohol Review on Thursday, were important partly because the alcohol industry is often involved in spreading health information to people around the world.

SOURCE: http://bit.ly/2wMhNCx
Drug Alcohol Rev 2017.

Thursday, September 7, 2017

Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis

Recommended Reading
April 2017 - Statins May Benefit Cirrhotic Patients with Hepatitis B or C Infections

Alimentary Pharmacology & Therapeutics  Volume 46, Issue 7
October 2017  Pages 673–680
Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis. A nationwide case-cohort study
C. Bang, T. Benfield, F. Bendtsen
First published: 7 September 2017
DOI: 10.1111/apt.14243

Full Text Article
View Online

Summary
Background
Reports have indicated that the use of statins may ameliorate the course of cirrhosis.

Aim
To determine the relationship between use of statins and mortality rate in patients with cirrhosis.

Methods
We did a retrospective case-cohort analysis based on data from the Danish registers from the period 1995 through 2014. Index date was time of diagnosis of cirrhosis (ICD-10: K703) and cohort entry depended on whether the patient was statin user or not. We used propensity score matching with a statin:non-statin ratio of 1:2. We included the exposure to statins (ATC classification C10AA) from the index date until death or end of follow-up based on prescription claims. Use of statins based on at least two statin claims as well as the longitudinal pattern over time of statin claims was tested against mortality. The main outcome was mortality rate.

Results
A total of 24 748 patients with alcoholic cirrhosis were identified and 5417 were eligible for matching. The mean age was 56 (SD 10) years and 36% were females. The prevalence of use of statins was 15%. We included 744 in the matched cohort. Mortality rates were 88 (95% CI 73-105) per 1000 years for patients using statin and 127 (95% CI 114-141) for non-statin patients with a HR of 0.57 (95% CI 0.45-0.71). A more regular pattern of statin claims was related to a lower risk of death.

Conclusions
Our results showed an association between regular use of statins and reduced mortality in patients with alcoholic cirrhosis.

Monday, August 28, 2017

HCV Disease Progression - Alcohol Consumption

HCV Disease Progression
When newly diagnosed with HCV the first thing on a patients mind (it was on mine) is how much liver damage do I have, and how will this virus progress overtime. Only by research into the natural history of hepatitis C can this be estimated. However, because the time of acute HCV infection is often impossible to establish, disease progression is difficult to determine. There is a general consensus after acquiring the virus it takes 10 to 15 years before evidence of the disease appears on biopsy or noninvasive tests used to measure fibrosis, 20 or so years to develop cirrhosis, and around another decade to develop liver cancer, but is influenced by several host factors, especially alcohol consumption.

Alcohol consumption
Researchers often reference a unique cohort of HCV patients when describing the natural history of hepatitis C. Never has there been a more perfect natural history study, in that, the known dates of infection were precise. The famous and tragic cohort include 704 Irish women and 917 German women exposed to hepatitis C from contaminated Anti-D immunoglobulin in 1977 and 1979. In the following cohort study published in Journal of Hepatology 2017 Aug 23, researchers looked at host and treatment factors to estimate the effect of disease progression in 682 Irish women mentioned in the above cohort. The authors wrote;

In the mid 1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36 years of infection. Disease progression accelerated in the latest five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.
View abstract, here.

2013 - German cohort of women after 35 years of infection
Going back to a study in 2013, in the German cohort of women after 35 years of infection, published in Hepatology, mild but significant disease progression at 35 years after infection is suggested, noting patients with self-limited HCV infection or who achieved SVR after antiviral treatment were protected from progressive liver disease and showed the best clinical long-term outcome.

2005 - German cohort of women after 25 years of infection
In 2005 a slow rate of disease progression in the German women after 25 years of infection is again suggested, given the high rate of spontaneous clearance (undetectable levels of the virus without initiating drug therapy.) as published in Journal of Hepatology. Comment on the study:

In sum, from the study of Wiese et al. [10] and a similar study in Ireland [11], one can conclude that a woman infected with HCV in her mid-20's has a near 50% chance of spontaneous recovery and in those with persistent infection, there is only a 5% probability of developing bridging fibrosis, cirrhosis or HCC during the first 25 years of infection. These relatively benign outcomes are quite encouraging, but this population represents a best-case scenario because of the young age and general good health at the onset of infection, and the rarity of co-morbid factors. Risk might increase slightly in males and would increase significantly in those infected at ages beyond 40, those with immunodeficiency states, those with excessive alcohol intake and perhaps those with high body mass index. Nonetheless, the 25-year outcome in the natural history of HCV infection is one of higher than expected spontaneous recovery and lower than predicted morbidity and mortality. Comment published in Journal of Hepatology.

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Read more about alcohol use and disease progression.
Tina