Alcohol‐related cirrhosis—early abstinence is a key factor in prognosis, even in the most severe cases

Verrill, Clare; Markham, H. C.; Templeton, Alexa; Carr, Norman J.; Sheron, Nick

doi:10.1111/j.1360-0443.2009.02521.x

Cited by 117 publications

(93 citation statements)

References 29 publications

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“…Once patients are seen by specialist liver services half will stop drinking, but half of these patients die before their liver has a chance to recover with only the remaining half surviving long term. 2 Of 4395 first admissions to Southampton General Hospital with cirrhosis or liver failure between 1996-2012, 3306 (75%) had not been seen previously in a liver clinic (N Sheron, unpublished data, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…3 One-third of ALD admissions die within a year as a result of liver failure or variceal haemorrhage, never having had the opportunity to benefit from abstention, whereas the survival curves in abstainers who survive this initial period are flat after about 18 months. 2 Patients are developing ALD in the community but it is not identified until they are admitted to hospital with endstage disease, by which time it is too late for many of them.…”

Section: Introductionmentioning

confidence: 99%

“…This contrasts with 50% of patients who stop drinking when informed by a liver specialist that they have alcohol related cirrhosis. 2 All liver disease follows a common pathway of fibrosis, leading to cirrhosis and finally chronic liver failure, or more commonly acute on chronic liver failure. The study therefore formed the hypothesis that if there was a liver test which could be used to detect liver fibrosis at an early stage in the community, and this information was fed…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

Sheron¹,

Moore

O’Brien³

et al. 2013

Br J Gen Pract

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BackgroundIn the past 15 years mortality rates from liver disease have doubled in the UK. Brief alcohol advice is cost effective, but clinically meaningful reductions in alcohol consumption only occur in around 1 in 10 individuals. AimTo provide evidence that detecting early liver disease in the community is feasible, practical, and that feedback of liver risk can increase the proportion of subjects reducing alcohol consumption. Design and settingA community feasibility study in nine general practice sites in Hampshire. MethodHazardous and harmful drinkers were identified by WHO AUDIT questionnaire and offered screening for liver fibrosis. ResultsIn total, 4630 individuals responded, of whom 1128 (24%) hazardous or harmful drinkers were offered a liver fibrosis check using the Southampton Traffic Light (STL) test; 393 (38%) attended and test results were returned by post. The STL has a low threshold for liver fibrosis with 45 (11%) red, 157 (40%) amber, and 191 (49%) green results. Follow-up AUDIT data was obtained for 303/393 (77%) and 76/153 (50%) subjects with evidence of liver damage reduced drinking by at least one AUDIT category (harmful to hazardous, or hazardous to low risk) compared with 52/150 (35%, P<0.011) subjects without this evidence; in the subset of harmful drinkers patterns (AUDIT >15), 22/34 (65%) of STL positives, reduced drinking compared with 10/29 (35%, P<0.017) STL negatives. ConclusionDetection of liver disease in the community is feasible, and feedback of liver risk may reduce harmful drinking.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

Sheron¹,

Moore

O’Brien³

et al. 2013

Br J Gen Pract

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“…20 Unfortunately, for many it is too late; one-third die early because they did not stop drinking in time, one-third die later from continued alcohol intake and one-third survive -we have termed this 'the law of thirds'. The quality of liver care may be a factor.…”

Section: Management Of Alcoholic Hepatitis and Decompensated Cirrhosismentioning

confidence: 99%

Alcoholic liver disease – the extent of the problem and what you can do about it

2015

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Alcoholic liver disease -the extent of the problem and what you can do about itIt takes upwards of ten years for alcohol-related liver disease to progress from fatty liver through fi brosis to cirrhosis to acute on chronic liver failure. This process is silent and symptom free and can easily be missed in primary care, usually presenting with advanced cirrhosis. At this late stage, management consists of expert supportive care, with prompt identifi cation and treatment of bleeding, sepsis and renal problems, as well as support to change behaviour and stop harmful alcohol consumption. There are opportunities to improve care by bringing liver care everywhere up to the standards of the best liver units, as detailed in the Lancet Commission report. We also need a fundamental rethink of the technologies and approaches used in primary care to detect and intervene in liver disease at a much earlier stage. However, the most effective and cost-effective measure would be a proper evidence-based alcohol strategy. Background -the scale of the issue in the UKThis review was drafted alongside the Lancet Commission: Addressing the crisis of liver disease in the UK; evidence-based recommendations of an expert panel aimed at tackling rising numbers of premature deaths due to liver injury.

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“…Short-term toxic effects of alcohol include facial flushing, tachycardia, palpitation, confused consciousness, vomiting, etc. Long-term excessive alcohol use leads to cirrhosis [1], alcohol liver disease [2], pancreatitis [3], neurologic [4], gastrointestinal damages [5], osteoporosis [6] and others. Several efforts have been made to relief alcohol toxicity using synthetic medicines or herb-based remedies.…”

Section: Introductionmentioning

confidence: 99%

Effect of <i>Elaeagnus Conferta</i> Roxb (Elaeagnaceae) Dry Fruit on the Activities of Hepatic Alcohol Dehydrogenase and Aldehyde Dehydrogenase in Mice

Wu¹,

Dai²,

Bai³

et al. 2011

Trop. J. Pharm Res

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Purposes: To determine the effect of Elaeagnus conferta Roxb dry fruit powder (ECR) on blood alcohol clearance and on the activities of hepatic alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). Methods:In a randomized controlled study, acute alcohol intoxication was induced in mice with Hongxing liquor containing 65 % v/v ethanol orally. The effect of ECR on blood alcohol clearance and on the activities of hepatic alcohol dehydrogenase and aldehyde dehydrogenase in the mice was then investigated. Results: A 30-min pretreatment with ECR at 400 and 800 mg/kg led to a faster clearance of blood alcohol after the alcohol ingestion. The concentration of blood alcohol at 4 h after alcohol ingestion decreased by 21.2 % in mice pretreated with 800 mg/kg ECR. The activities of hepatic alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) were enhanced by ECR. Conclusion: These results suggest that pretreatment with ECR might stimulate the clearance of blood alcohol by increasing the activities of hepatic alcohol dehydrogenase and aldehyde dehydrogenase.

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Alcohol‐related cirrhosis—early abstinence is a key factor in prognosis, even in the most severe cases

Abstract: It is never too late to stop drinking, even with the most severe degrees of cirrhosis on biopsy. Early drinking status is the most important factor determining long-term survival in alcohol-related cirrhosis.

Cited by 117 publications

References 29 publications

Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

Alcoholic liver disease – the extent of the problem and what you can do about it

Effect of <i>Elaeagnus Conferta</i> Roxb (Elaeagnaceae) Dry Fruit on the Activities of Hepatic Alcohol Dehydrogenase and Aldehyde Dehydrogenase in Mice

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