Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide

Shah, Neil; Ventura-Cots, Meritxell; Abraldes, Juan G.; Alboraie, Mohamed; Alfadhli, Ahmad; Argemí, Josepmaria; Badia-Aranda, Ester; Arús-Soler, Enrique; Barritt, A. Sidney; Bessone, Fernando; Biryukova, Marina; Carrilho, Flair José; Fernández, Marlen Ivón Castellanos; Guiridi, Zaily Dorta; Kassas, Mohamed El; Teo, Eng–Kiong; Farias, Alberto Queiróz; George, Jacob; Gui, Wenfang; Thurairajah, Prem Harichander; Hsiang, John; Husić-Selimović, Azra; Isakov, Vasily; Karoney, Mercy Jelagat; Kim, Won; Kluwe, Johannes; Kochhar, Rakesh; Dhaka, Narendra; Costa, Pedro; Pharm, Mariana A. Nabeshima; Ono, Suzane Kioko; Reis, Daniela; Rodil, Agustina; Domech, Caridad Ruenes; Sáez-Royuela, F; Scheurich, C; Siow, Way; Sivac-Burina, Nadja; Traquino, Edna Solange Dos Santos; Some, Fatma; Sprečkić, Sanjin; Sheng, T. T.; Vorobioff, Julio; Wandera, Andrew; Wu, Pengbo; Yacoub, Mohamed; Yang, Ling; Yu, Yuanjie; Zahiragic, Nerma; Zhang, Chaoqun; Cortez‐Pinto, Helena; Bataller, Ramón

doi:10.1016/j.cgh.2019.01.026

Cited by 109 publications

(74 citation statements)

References 18 publications

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“…As a result, around the world, ALD is recognized late in its course, even in specialist centers. ( 4 ) Furthermore, most patients with a new diagnosis of ALD report prior interactions with health care providers over their lifetime, when opportunities for screening for alcohol use disorder (AUD) and detecting ALD at an early stage were missed. ( 5 ) Recent guidelines into the management of ALD have highlighted the need for better communication between practitioners in addiction, and those in general and specialized medicine and surgery.…”

Section: Figmentioning

confidence: 99%

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

Lucey

Singal

2020

Hepatology

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A lcohol-associated liver disease (ALD) contributes to 50% of cases of cirrhosis worldwide. (1) Despite this burden of disease, the resources devoted to either research into or treatment of ALD have lagged compared with liver diseases from other etiologies. (2,3) Progress has been hampered by the isolation of addiction medical services from internal medicine, family medicine, and gastroenterology-hepatology. As a result, around the world, ALD is recognized late in its course, even in specialist centers. (4) Furthermore, most patients with a new diagnosis of ALD report prior interactions with health care providers over their lifetime, when opportunities for screening for alcohol use disorder (AUD) and detecting ALD at an early stage were missed. (5) Recent guidelines into the management of ALD have highlighted the need for better communication between practitioners in addiction, and those in general and specialized medicine and surgery. (2,3) However, we take hope from two papers in this issue of Hepatology that point to the future for better care for patients with ALD. (6,7) In the first study, Preoschold-Bell et al. compared Screening, Brief Intervention, and Referral to Treatment (SBIRT) with SBIRT and enhanced treatment of AUD, with an aim to reduce alcohol consumption in patients with hepatitis C virus (HCV) infection. (7) Subjects attending three out-patient clinics from October 2014 to September 2017 were identified as candidates for the study using the AUD Identification Test questionnaire. The primary outcome of abstinence from alcohol at 6 months improved similarly in both groups. For example, abstinence at month 6 in the SBIRT-only group improved to 20.5% from 7.1% at day 0, and the SBIRT plus intensive treatment of AUD group improved to 23.3% from 4.2% at baseline. Similar results were obtained for evaluation on heavy drinking days, number of heavy drinking days per month, decreasing the amount of alcohol consumption per week, and use of other recreational drugs. This study makes the important point that improvements in drinking behavior are possible with concerted medical intervention. It should be acknowledged that this study included patients with mild AUD, limiting the applicability to the patients usually seen in liver units. Furthermore, all patients in this study received screening for AUD, raising awareness, which is not the standard of care for HCV infection treatment in routine practice. Apart from SBIRT, two other psychosocial interventions for managing more severe AUD or alcohol dependence include cognitive behavioral therapy (12-step abstinence-based program that involves Alcoholics Anonymous, focusing on identifying triggers that endanger relapse and how to deal with these) and motivational enhancement therapy (technique dealing with the patient dilemma, focusing on the decision to stop or modify drinking behavior).

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Section: Figmentioning

confidence: 99%

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

Lucey

Singal

2020

Hepatology

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“…34 One of the challenges of reducing the burden of severe ALD is the lack of early detection of silent liver disease among heavy drinkers. A recent global study, including countries from 5 continents, showed that ALD is the liver disease in which by far the most patients are seen at advanced stages 35 ( Fig. 1).…”

Section: Factors Influencing the Burden Of Alcoholrelated Liver Diseasementioning

confidence: 99%

Public health policies and alcohol-related liver disease

et al. 2019

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Alcohol-related liver disease (ALD) represents a major public health problem worldwide. According to the World Health Organization, the highest levels of per capita alcohol consumption are observed in countries of the European Region. Alcohol consumption is also alarmingly increasing in developing countries. ALD is one of the main contributors to the burden of alcoholattributable deaths and disability. In the United States, severe forms of ALD such alcoholic hepatitis have increased in the last decade and in the United Kingdom, three-quarters of liver-related mortality results from alcohol consumption. Besides genetic factors, there is strong evidence that the amount of alcohol consumed plays a major role in the development of advanced ALD. Establishing effective public health policies is therefore mandatory to reduce the burden of ALD. Since the 90s, major public health institutions and governments have developed a variety of policies in order to reduce the harm caused by excessive drinking. These policies encompass multiple factors, from pricing and taxation to advertising regulation. Measures focused on taxation and price regulation have been shown to be the most effective at reducing alcohol-related mortality. However, there are few studies focused on the effect of public policies on ALD. This review article summarises the factors influencing ALD burden and the role of different public health policies.

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“…It should be noted that the OS of this cohort was lower than that at other sites [21][22][23][24][25][26][27][28][29] (Supplementary table 6), despite similar patient selection, supraselective procedures and response to therapy. We speculate that although alcohol aetiology is not an independent predictor of survival, alcohol consumption can impair liver function due to acute-onchronic liver failure [30] or alcoholic hepatitis [31,32]. The poor prognosis of alcohol-related HCC has been specifically observed in some French cohort studies [33,34] and in patients treated with Y 90radioembolization in the SORAMIC study [35].…”

Section: Discussionmentioning

confidence: 99%

The development of early ascites is associated with shorter overall survival in patients with hepatocellular carcinoma treated with drug-eluting embolic chemoembolization

Pipa-Muniz

Sanmartino

Mesa

et al. 2020

Preprint

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Background: A single-centre cohort study was performed to identify the independent factors associated withthe overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). Methods : A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with overall survival after DEB-TACE, stressing the role of post-TACE events, was performed. Results: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, tumor size, AFP < 100 ng/mL and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. Conclusions : Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.

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Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide

Cited by 109 publications

References 18 publications

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

Public health policies and alcohol-related liver disease

The development of early ascites is associated with shorter overall survival in patients with hepatocellular carcinoma treated with drug-eluting embolic chemoembolization

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