Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver Function

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FULL TEXT: http://www.medscape.com/viewarticle/577881?src=mp & spon=20 & uac=31238BR

From The American Journal of Gastroenterology

Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver

Function

Posted 09/25/2008

R. Lucey, M.D.; T. Connor, Ph.D.; D. Boyer, M.D.; J.

, M.D.; Layton F. Rikkers, M.D.; and the DIVERT Study Group

Abstract and Introduction

Abstract

Objective: We investigated patterns of use of alcohol and its clinical effects

among cirrhotic subjects who participated in a randomized clinical trial

comparing the efficacy of transjugular intravenous portosystemic shunt and

distal splenorenal shunt.

Methods: There were 132 cirrhotic subjects, 78 with alcoholic liver disease

(ALD), who were followed for a median of 49 months (range 2–93 months). Alcohol

use was assessed by patient questionnaire, with corroboration by family members.

Results: Twenty-eight subjects (21%) were drinking at study entry and 60

subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was

recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking

by ALD subjects was associated with a 153% increase in gamma-glutamyl

transpeptidase (GGT) (P < 0.0001). The frequencies of death (46% vs 30%),

ascites (33% vs 20%), encephalopathy (56% vs 42%), and variceal bleeding (11% vs

3%) were greater in the ALD group. In a proportional hazards model only

" ever heavy drinking " was associated with death (P = 0.0099), while recent heavy

drinking increased the hazard of variceal hemorrhage dramatically (odds ratio

10.85).

Conclusions: Whereas most cirrhotic subjects, alcoholic or not, did not drink

during 5 yr of observation, heavy alcohol use occurred exclusively in ALD

patients. Alcohol use by ALD subjects was associated with elevations in GGT and

was linked to death and with rebleeding from shunt dysfunction.

Introduction

The impact of alcohol consumption on the outcome of alcoholic cirrhosis remains

controversial.[1, 2] Difficulty in follow-up, in verifying data on alcohol use,

and the confounding effects of portal hypertension limit many studies.[3,4]

Most, but not all, studies indicate that continued alcohol use by patients with

alcoholic liver disease (ALD) is associated with increased mortality.[1,2,5-10]

In particular, it remains uncertain whether alcohol use is temporally associated

with increases in portal pressure or initiation of variceal hemorrhage.[11-14]

The Decompression Intervention of Variceal Rebleeding Trial (DIVERT) study is a

randomized controlled trial (RCT) comparing the efficacy of transjugular

intravenous portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) in

patients with cirrhosis of any cause who had failed pharmacological or

endoscopic therapy for variceal hemorrhage.[15] All subjects, alcoholic and

nonalcoholic alike, were interviewed about alcohol use at regular intervals

throughout the study. Consequently, the DIVERT study data set provides an

exceptional opportunity to explore the effects of alcohol use by patients with

cirrhosis. Our purpose in the present article is to investigate patterns of

alcohol use revealed by the prospective DIVERT database and to analyze the

effect of alcohol use on liver function and decompensation in this population of

cirrhotics who carried a minimal risk of further variceal bleeding.

[Guest guest]

FULL TEXT: http://www.medscape.com/viewarticle/577881?src=mp & spon=20 & uac=31238BR

From The American Journal of Gastroenterology

Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver

Function

Posted 09/25/2008

R. Lucey, M.D.; T. Connor, Ph.D.; D. Boyer, M.D.; J.

, M.D.; Layton F. Rikkers, M.D.; and the DIVERT Study Group

Abstract and Introduction

Abstract

Objective: We investigated patterns of use of alcohol and its clinical effects

among cirrhotic subjects who participated in a randomized clinical trial

comparing the efficacy of transjugular intravenous portosystemic shunt and

distal splenorenal shunt.

Methods: There were 132 cirrhotic subjects, 78 with alcoholic liver disease

(ALD), who were followed for a median of 49 months (range 2–93 months). Alcohol

use was assessed by patient questionnaire, with corroboration by family members.

Results: Twenty-eight subjects (21%) were drinking at study entry and 60

subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was

recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking

by ALD subjects was associated with a 153% increase in gamma-glutamyl

transpeptidase (GGT) (P < 0.0001). The frequencies of death (46% vs 30%),

ascites (33% vs 20%), encephalopathy (56% vs 42%), and variceal bleeding (11% vs

3%) were greater in the ALD group. In a proportional hazards model only

" ever heavy drinking " was associated with death (P = 0.0099), while recent heavy

drinking increased the hazard of variceal hemorrhage dramatically (odds ratio

10.85).

Conclusions: Whereas most cirrhotic subjects, alcoholic or not, did not drink

during 5 yr of observation, heavy alcohol use occurred exclusively in ALD

patients. Alcohol use by ALD subjects was associated with elevations in GGT and

was linked to death and with rebleeding from shunt dysfunction.

Introduction

The impact of alcohol consumption on the outcome of alcoholic cirrhosis remains

controversial.[1, 2] Difficulty in follow-up, in verifying data on alcohol use,

and the confounding effects of portal hypertension limit many studies.[3,4]

Most, but not all, studies indicate that continued alcohol use by patients with

alcoholic liver disease (ALD) is associated with increased mortality.[1,2,5-10]

In particular, it remains uncertain whether alcohol use is temporally associated

with increases in portal pressure or initiation of variceal hemorrhage.[11-14]

The Decompression Intervention of Variceal Rebleeding Trial (DIVERT) study is a

randomized controlled trial (RCT) comparing the efficacy of transjugular

intravenous portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) in

patients with cirrhosis of any cause who had failed pharmacological or

endoscopic therapy for variceal hemorrhage.[15] All subjects, alcoholic and

nonalcoholic alike, were interviewed about alcohol use at regular intervals

throughout the study. Consequently, the DIVERT study data set provides an

exceptional opportunity to explore the effects of alcohol use by patients with

cirrhosis. Our purpose in the present article is to investigate patterns of

alcohol use revealed by the prospective DIVERT database and to analyze the

effect of alcohol use on liver function and decompensation in this population of

cirrhotics who carried a minimal risk of further variceal bleeding.

[Guest guest]

FULL TEXT: http://www.medscape.com/viewarticle/577881?src=mp & spon=20 & uac=31238BR

From The American Journal of Gastroenterology

Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver

Function

Posted 09/25/2008

R. Lucey, M.D.; T. Connor, Ph.D.; D. Boyer, M.D.; J.

, M.D.; Layton F. Rikkers, M.D.; and the DIVERT Study Group

Abstract and Introduction

Abstract

Objective: We investigated patterns of use of alcohol and its clinical effects

among cirrhotic subjects who participated in a randomized clinical trial

comparing the efficacy of transjugular intravenous portosystemic shunt and

distal splenorenal shunt.

Methods: There were 132 cirrhotic subjects, 78 with alcoholic liver disease

(ALD), who were followed for a median of 49 months (range 2–93 months). Alcohol

use was assessed by patient questionnaire, with corroboration by family members.

Results: Twenty-eight subjects (21%) were drinking at study entry and 60

subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was

recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking

by ALD subjects was associated with a 153% increase in gamma-glutamyl

transpeptidase (GGT) (P < 0.0001). The frequencies of death (46% vs 30%),

ascites (33% vs 20%), encephalopathy (56% vs 42%), and variceal bleeding (11% vs

3%) were greater in the ALD group. In a proportional hazards model only

" ever heavy drinking " was associated with death (P = 0.0099), while recent heavy

drinking increased the hazard of variceal hemorrhage dramatically (odds ratio

10.85).

Conclusions: Whereas most cirrhotic subjects, alcoholic or not, did not drink

during 5 yr of observation, heavy alcohol use occurred exclusively in ALD

patients. Alcohol use by ALD subjects was associated with elevations in GGT and

was linked to death and with rebleeding from shunt dysfunction.

Introduction

The impact of alcohol consumption on the outcome of alcoholic cirrhosis remains

controversial.[1, 2] Difficulty in follow-up, in verifying data on alcohol use,

and the confounding effects of portal hypertension limit many studies.[3,4]

Most, but not all, studies indicate that continued alcohol use by patients with

alcoholic liver disease (ALD) is associated with increased mortality.[1,2,5-10]

In particular, it remains uncertain whether alcohol use is temporally associated

with increases in portal pressure or initiation of variceal hemorrhage.[11-14]

The Decompression Intervention of Variceal Rebleeding Trial (DIVERT) study is a

randomized controlled trial (RCT) comparing the efficacy of transjugular

intravenous portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) in

patients with cirrhosis of any cause who had failed pharmacological or

endoscopic therapy for variceal hemorrhage.[15] All subjects, alcoholic and

nonalcoholic alike, were interviewed about alcohol use at regular intervals

throughout the study. Consequently, the DIVERT study data set provides an

exceptional opportunity to explore the effects of alcohol use by patients with

cirrhosis. Our purpose in the present article is to investigate patterns of

alcohol use revealed by the prospective DIVERT database and to analyze the

effect of alcohol use on liver function and decompensation in this population of

cirrhotics who carried a minimal risk of further variceal bleeding.

[Guest guest]

FULL TEXT: http://www.medscape.com/viewarticle/577881?src=mp & spon=20 & uac=31238BR

From The American Journal of Gastroenterology

Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver

Function

Posted 09/25/2008

R. Lucey, M.D.; T. Connor, Ph.D.; D. Boyer, M.D.; J.

, M.D.; Layton F. Rikkers, M.D.; and the DIVERT Study Group

Abstract and Introduction

Abstract

Objective: We investigated patterns of use of alcohol and its clinical effects

among cirrhotic subjects who participated in a randomized clinical trial

comparing the efficacy of transjugular intravenous portosystemic shunt and

distal splenorenal shunt.

Methods: There were 132 cirrhotic subjects, 78 with alcoholic liver disease

(ALD), who were followed for a median of 49 months (range 2–93 months). Alcohol

use was assessed by patient questionnaire, with corroboration by family members.

Results: Twenty-eight subjects (21%) were drinking at study entry and 60

subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was

recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking

by ALD subjects was associated with a 153% increase in gamma-glutamyl

transpeptidase (GGT) (P < 0.0001). The frequencies of death (46% vs 30%),

ascites (33% vs 20%), encephalopathy (56% vs 42%), and variceal bleeding (11% vs

3%) were greater in the ALD group. In a proportional hazards model only

" ever heavy drinking " was associated with death (P = 0.0099), while recent heavy

drinking increased the hazard of variceal hemorrhage dramatically (odds ratio

10.85).

Conclusions: Whereas most cirrhotic subjects, alcoholic or not, did not drink

during 5 yr of observation, heavy alcohol use occurred exclusively in ALD

patients. Alcohol use by ALD subjects was associated with elevations in GGT and

was linked to death and with rebleeding from shunt dysfunction.

Introduction

The impact of alcohol consumption on the outcome of alcoholic cirrhosis remains

controversial.[1, 2] Difficulty in follow-up, in verifying data on alcohol use,

and the confounding effects of portal hypertension limit many studies.[3,4]

Most, but not all, studies indicate that continued alcohol use by patients with

alcoholic liver disease (ALD) is associated with increased mortality.[1,2,5-10]

In particular, it remains uncertain whether alcohol use is temporally associated

with increases in portal pressure or initiation of variceal hemorrhage.[11-14]

The Decompression Intervention of Variceal Rebleeding Trial (DIVERT) study is a

randomized controlled trial (RCT) comparing the efficacy of transjugular

intravenous portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) in

patients with cirrhosis of any cause who had failed pharmacological or

endoscopic therapy for variceal hemorrhage.[15] All subjects, alcoholic and

nonalcoholic alike, were interviewed about alcohol use at regular intervals

throughout the study. Consequently, the DIVERT study data set provides an

exceptional opportunity to explore the effects of alcohol use by patients with

cirrhosis. Our purpose in the present article is to investigate patterns of

alcohol use revealed by the prospective DIVERT database and to analyze the

effect of alcohol use on liver function and decompensation in this population of

cirrhotics who carried a minimal risk of further variceal bleeding.