Einfluß von Alkohol auf die Hämodynamik der Pfortader bei nutritiv-toxischer Leberzirrhose

Klein, Christian; Kalk, J F; Müting, D; Klein, Christian

doi:10.1055/s-2008-1059304

Cited by 17 publications

(7 citation statements)

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“…The mechanisms underlying the consequences of alcohol consumption on liver-related outcomes are possibly related to the worsening of portal hemodynamics. Alcohol use can deteriorate portal hypertension in patients with cirrhosis not only due to structural changes but also by modulating its dynamic component [32] leading to acute and chronic increases in intrahepatic vascular resistance [33,34]. Long-term abstinence has been linked to significant decreases of up to 40% in portal pressure which leads to regression of varices and reduced occurrence of portal hypertension-related complications [28].…”

Section: Discussionmentioning

confidence: 99%

Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: a retrospective study of 440 patients

Kalambokis,

Chouliara,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Background and aim The prevalence of alcohol-associated cirrhosis is increasing. In this respect, we investigated the long-term impact of non-abstinence on the clinical course of alcohol-associated cirrhosis. Methods We retrospectively evaluated 440 patients with alcohol-associated cirrhosis (compensated cirrhosis: n = 190; decompensated cirrhosis: n = 250) diagnosed between January 2000 and July 2017 who consumed alcohol until diagnosis of cirrhosis. We assessed liver-related outcomes including first and further decompensating events (ascites, variceal bleeding, and hepatic encephalopathy), and death in relation to continued alcohol use. Results Overall, 53.6% of patients remained abstinent (compensated cirrhosis: 57.9%; decompensated cirrhosis: 50.4%). Non-abstinent versus abstinent patients with compensated cirrhosis and decompensated cirrhosis showed significantly higher 5-year probability of first decompensation (80.2% vs. 36.8%; P < 0.001) and further decompensation (87.9% vs. 20.6%; P < 0.001), respectively. Five-year survival was substantially lower among non-abstinent patients with compensated cirrhosis (45.9% vs. 90.7%; P < 0.001) and decompensated cirrhosis (22.9% vs. 73.8%; P < 0.001) compared to abstinent. Non-abstinent versus abstinent patients of the total cohort showed an exceedingly lower 5-year survival (32.2% vs. 82.4%; P < 0.001). Prolonged abstinence (≥2 years) was required to influence outcomes. Non-abstinence independently predicted mortality in the total cohort (hazard ratio [HR] 3.371; confidence interval [CI]: 2.388–4.882; P < 0.001) along with the Child-Pugh class (HR: 4.453; CI: 2.907–6.823; P < 0.001) and higher age (HR: 1.023; CI: 1.007–1.039; P = 0.005). Conclusion Liver-related outcomes are worse among non-abstinent patients with alcohol- associated cirrhosis prompting urgent interventions ensuring abstinence.

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Section: Discussionmentioning

confidence: 99%

Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: a retrospective study of 440 patients

Kalambokis,

Chouliara,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“…The interruption of etiology is the most important step, mainly with respect to the progression of liver disease but also with respect to an immediate portal pressure-lowering effect. This holds true for the interruption of hepatitis C 91 – 93 or abstinence from alcohol 94 . Since chronic alcoholism is now the most frequent cause of liver cirrhosis and portal hypertension in most countries, we need a more holistic approach to alcohol use disorders 95 , 96 .…”

Section: Modification Of Portal Pressure By Non-specific Drugsmentioning

confidence: 94%

“…Thus, it is eminently worthwhile to support beneficial change in the eating or drinking habits of patients, which are controlled by the brain. It has been shown that in patients with liver cirrhosis, weight loss 200 or abstinence from alcohol 94 , 201 significantly reduces portal hypertension. This appears to be the most important strategy to influence the gut–liver axis and portal hypertension ( Figure 1 ).…”

Section: Modulation Of the Intestinementioning

confidence: 99%

Managing portal hypertension in patients with liver cirrhosis

2018

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Portal hypertension is one cause and a part of a dynamic process triggered by chronic liver disease, mostly induced by alcohol or incorrect nutrition and less often by viral infections and autoimmune or genetic disease. Adequate staging - continuously modified by current knowledge - should guide the prevention and treatment of portal hypertension with defined endpoints. The main goals are interruption of etiology and prevention of complications followed, if necessary, by treatment of these. For the past few decades, shunts, mostly as intrahepatic stent bypass between portal and hepatic vein branches, have played an important role in the prevention of recurrent bleeding and ascites formation, although their impact on survival remains ambiguous. Systemic drugs, such as non-selective beta-blockers, statins, or antibiotics, reduce portal hypertension by decreasing intrahepatic resistance or portal tributary blood flow or by blunting inflammatory stimuli inside and outside the liver. Here, the interactions among the gut, liver, and brain are increasingly examined for new therapeutic options. There is no general panacea. The interruption of initiating factors is key. If not possible or if not possible in a timely manner, combined approaches should receive more attention before considering liver transplantation.

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“…Об этом свидетельствуют наблюдения за больными алкогольным ЦП, описанные еще в начале 90-х гг. прошлого столетия, у которых длительное воздержание от приема алкоголя способствовало регрессии варикознорасширенных вен пищевода [56] и сопровождалось снижением заклиненного печеночного венозного давления на 46% [57].…”

Section: текущие подходы к лечению алкоголь-индуцированного фиброза п...unclassified

Principles of diagnosis and treatment of alcohol-induced liver fibrosis

Garbuzenko

2022

Medicinskij sovet

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Alcohol-related liver diseases are one of the leading causes of death worldwide, primarily due to complications of liver cirrhosis (LC). Early detection of alcohol-induced liver fibrosis (LF) is a difficult task, since often alcoholic liver disease (ALD) is clinically manifested only at late stages. Given that not all alcoholic suffer from ALD, the widespread use of liver biopsy to verify the diagnosis is not advisable. Despite the variety of proposed non-invasive methods for assessing the severity of LF in patients with ALD, none of them has sufficient validation and therefore cannot be recommended for widespread use in clinical practice. The most well-studied transient elastography, due to its suboptimal specificity, can be effectively used only to exclude clinically significant LF or LC. The only proven approach to treat ALD is persistent and total alcohol abstinence. While the therapeutic options for patients with severe forms of acute hepatitis remain unchanged since the 70s of the last century and are based mainly on the use of corticosteroids, currently, there are no approaches to antifibrotic therapy of ALD approved by the guidelines. At the same time, modern achievements in understanding the pathophysiological mechanisms of this disease have served as an impetus for the development of ways to solve the problem. In particular, providing intestinal eubiosis may be an important goal for the prevention and treatment of alcohol-induced LF. Randomized controlled multicenter trials involving a large number of patients are needed to confirm this and other hypotheses related to antifibrotic therapy of ALD and to accept them as a standard of medical care.

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Einfluß von Alkohol auf die Hämodynamik der Pfortader bei nutritiv-toxischer Leberzirrhose

Cited by 17 publications

References 0 publications

Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: a retrospective study of 440 patients

Impact of continued alcohol use on liver-related outcomes of alcohol-associated cirrhosis: a retrospective study of 440 patients

Managing portal hypertension in patients with liver cirrhosis

Principles of diagnosis and treatment of alcohol-induced liver fibrosis

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