In a continuing screening and intervention programme in Malmó, elevated serum-gamma-glutamyltransferase (GGT) values were used for selection of heavy drinkers. The study population consisted of 585 individuals born 1926-1933 with two consecutive GGT values in the upper decile of the GGT distribution, randomly allocated either to an intervention group of to a control group. The subjects in the intervention group were further investigated and 75% of them were judged to have elevated GGT values caused by alcohol consumption. These individuals were repeatedly encouraged to lower their overall alcohol consumption and GGT measurements were used as biofeedback method in the treatment program. The controls were informed by letter to be restrictive with their alcohol consumption and that they should receive new invitations for measurements of their liver enzymes after 2, 4, and 6 years. The intervention and control groups were well matched and followed over a 2-6-year period. Two and 4 years after the screening investigation, the GGT values in both groups were significantly decreased. There were differences, however, between the two groups with regard to sick absenteeism, hospitalization, and mortality. A significant reduction was found in sick absence during 4 years by 80%, in hospital days during 5 years by 60%, and in mortality during 6 years by 50% in the intervention group compared with the control group. Thus, the intervention program was effective in preventing medico-social consequences of heavy drinking.

A young woman with a previous history of anorexia nervosa presented with severe finger clubbing. Urine samples intermittently contained significant amounts of aspartylglucosamine. Liver biopsy showed abnormal cytoplasmic inclusions in phagocytic cells. The patient was found to be abusing senna laxative.