Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

Comorbilidades en pacientes con enfermedad hepática alcohólica / Comorbidities in patients with alcoholic hepatic disease

Introducción: El consumo excesivo y prolongado de alcohol se asocia a una morbilidad elevada por afecciones hepáticas y de otros órganos. Objetivo: Precisar las lesiones hepáticas y su relación con otras enfermedades asociadas al alcohol y el estado nutricional en pacientes con enfermedad hepática alcohólica. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de 270 pacientes con enfermedad hepática alcohólica, atendidos en el Servicio de Medicina Interna y la consulta especializada de Hepatología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de Santiago de Cuba, quienes fueron examinados clínicamente para detectar síntomas y signos de enfermedades hepática y asociadas al alcohol en diferentes sistemas, durante el decenio 2010-2019. Resultados: Predominaron los hombres (234), de los cuales 117 estuvieron en el grupo de 25 - 44 años de edad. La forma clínica preponderante fue la cirrosis hepática en 109 pacie2ntes, de ellos una proporción importante eran bebedores con más de 20 años de exposición al hábito. La enfermedad por reflujo gastroesofágico junto a las formas de gastropatía y la polineuropatía en 89 y 96 afectados, respectivamente, fueron las comorbilidades más asociadas a la lesión hepática. Se observaron diferentes grados de desnutrición en 167 afectados (61,8 %), de los cuales primaron aquellos con cirrosis hepática, de estos 51 (49,0 %) presentaron desnutrición moderada y 31 (49,2 %) grave. Conclusiones: Resulta elevada la presencia de comorbilidades en pacientes con enfermedad hepática alcohólica, lo cual se asocia al deterioro nutricional y a una exposición prolongada al hábito nocivo.

Introduction: The excessive and prolonged consumption of alcohol is associated with a high morbidity due to hepatic disorders and affections of other organs. Objective: To specify the hepatic lesions and their relationship with other diseases associated with alcohol and the nutritional state in patients with alcoholic hepatic disease. Methods: An observational, descriptive and cross-sectional study of 270 patients with alcoholic hepatic disease was carried out. They were assisted in the Internal Medicine Service and in the specialized visit of Hepatology from Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba who were clinically examined to detect symptoms and signs of hepatic disease and those associated with alcohol in different systems, during the decade 2010-2019. Results: There was a prevalence of men (234), of which 117 were in the group of 25 - 44 years of age. The preponderant clinical form was the hepatic cirrhosis in 109 patients, an important proportion of them were drinkers with more than 20 years of exhibition to the habit. The disease due to gastroesophagic reflux along with the forms of gastropathy and polyneuropathy in 89 and 96 affected patients, respectively, were the comorbidities more associated with the hepatic lesion. Different degrees of malnutrition were observed in 167 affected patients (61.8 %), of which those with hepatic cirrhosis prevailed, of these 51 (49.0 %) presented moderate malnutrition and 31 (49.2 %) a serious one. Conclusions: The presence of comorbidities in patients with alcoholic hepatic disease is high, which is associated to the nutritional deterioration and a prolong exposure to the harmful habit.

Anemia in Chronic Liver Disease and Liver Failure in Adults - A Clinical Study

Introduction: Chronic liver disease with or without liverfailure is associated with considerable morbidity andmortality and affects the quality of life as usually they areprogressive and often non-reversible. In the present study wehave attempted to look at the clinical presentation, etiologiesand anemia profile for chronic liver disease patients in ourpopulation. Curent study aimed to assess the clinical profileand type of anemia in chronic liver disease and liver failurein adult patients.Material and Methods: This was a prospective observationalhospital-based study carried out in the department of GeneralMedicine at, over a period of eighteen months. A total of 38patients with chronic liver disease with/without liver failurewere studied for patient demographics, clinical presentation,symptomatology, for etiology of the disease, for degree ofanemia and morphologic type of anemia.Results: The patient age ranged from 19 to 76 years and themale to female ratio was 2.8:1. CLD was most common inthe fifth and sixth decades of life. Malaise, nausea, emesis,jaundice, anemia and hepatomegaly were the most commonclinical features. Most (44.7%) cases were of chronic hepatitiswith cirrhosis. Alcoholic liver disease and HBV infectionwere the most common causes for CLD and liver failure. Atotal of 33 (86.8%) patients had anemia and the normocyticnormochromic type of anemia was the most common (39.4%)type seen.Conclusion: Chronic liver disease and liver failure are morecommon in the fifth and sixth decades of life and are mostoften caused by alcoholic liver disease and HBV infection inIndia. CLD has varied clinical presentation with symptomsoften related to the gastrointestinal tract and organomegaly.It is frequently associated with moderate degree of anemiawhich is often of normocytic type.

Bilateral optic neuropathy related to severe anemia in a patient with alcoholic cirrhosis: A case report and review of the literature

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.

Contrast analysis of nutritional status between patients of alcoholic cirrhosis and viral cirrhosis / 肠外与肠内营养

Objective:To compare the nutritional status between alcoholic cirrhosis and viral cirrhosis,and to provide reference information for the nutritional support strategy.Methods:95 alcoholic cirrhosis and 260 viral cirrhosis patients were involved in the study.The patients were reviewed with NRS 2002 and SGA within 48 hours after admission.The general information and liver function parameters including gender,age,BMI,Child-Pugh score,ALB,PA and Hb were recorded.Results:The NRS 2002 nutritional risk rate of alcoholic cirrhosis and viral cirrhosis patients was 76.80％ and 65.00％,respectively.The SGA malnutrition rate of alcoholic cirrhosis and viral cirrhosis patients was 67.40％ and 61.90％,respectively.There was statistically significant difference between the two groups in gender,Child-Pugh A rate,ALB,PA,Hb and NRS 2002,while there was no significant difference in age,Child-Pugh B rate,Child-Pugh C rate,BMI and SGA.Conclusion:Nutritional dysfunction exists in both of the two types of liver cirrhosis.The nutritional risk rate and the anemia rate in alcoholic cirrhosis patients are significantly worse than those in viral cirrhosis patients.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community

OBJECTIVE: Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. METHODS: One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. RESULTS: Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38-29.71 and p < 0.001, OR = 13.65, 95% CI 4.71-39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. CONCLUSIONS: Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Pattern of diastolic dysfunction in alcoholic and non-alcoholic cirrhotic portal hypertensive patients with or without ascites in rural population in South India.

Background: Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study, we evaluated the association between severity of diastolic dysfunction and severity of cirrhosis in alcoholic and non-alcoholic cirrhotic patients with or without ascites in rural population in South India. Methods: This cross-sectional study was conducted on alcoholic and non-alcoholic cirrhotic patients coming from rural background admitted in a tertiary hospital in South India from January 2014 to March 2015. 60 patients were enrolled. Severity of cirrhosis was evaluated by Child-Pugh score. A 12-lead surface ECG and echocardiographic studies were performed. Results: Seventy eight percent of patients were male. The mean age of patients was 58.98 ± 15.2 years. 21%, 37%, and 42% of patients were considered as child class A, B, and C, respectively. There was a significant relation between diastolic dysfunction and disease duration (P=0.001), age >60 years (P=0.004), and severity of cirrhosis (P=0.003). Conclusions: Because of high prevalence of diastolic dysfunction in cirrhotic patients and risk of decompensation following invasive procedures, it could be suggested that all patients would be screened routinely by echocardiography before invasive procedures. According to the relation between Child-Pugh score and diastolic dysfunction, it is recommended for cardiac assessment, especially echocardiographic evaluation in all cirrhotic patients. In conclusion, left ventricular diastolic dysfunction is commonly associated with advancement of hepatic dysfunction while systolic function is maintained till advanced hepatic failure.

Diet & nutrition profile of Chenchu population - a vulnerable tribe in Telangana & Andhra Pradesh, India.

Background & objectives: Earlier studies have documented high prevalence of undernutrition, morbidity and mortality among Chenchus, a tribal population in Telangana and Andhra Pradesh, India. The present study was carried out to assess diet and nutritional status of Chenchus and cause of death. Methods: A total of 42 Chenchu villages (gudems) were covered using systematic random sampling procedure. In each gudem, all the households with at least one child under the age of five years were covered for various investigations. Weighment diet survey was carried out on a sub-sample of households. In addition, information on cause of death in the selected 42 gudems was collected for past one year using verbal autopsy method. Results: A total of 1396 subjects of all age groups were covered for various investigations. The intakes of food and nutrients were lower than the recommended levels. The prevalences of underweight, stunting and wasting among under five children were 42 per cent (CI: 37.9-46.1), 53 and 13 per cent, respectively, while 41 per cent (CI: 37.8-47.2) men and 42 per cent (34.4-47.8) women had chronic energy deficiency (BMI<18.5 kg/m2). Sixty eight deaths were reported during the past one year in 42 Chenchu gudems. The major causes of death were premature delivery, low birth weight, alcoholic cirrhosis of liver, accidents, snakebite and pulmonary tuberculosis. Interpretation & conclusions: The prevalence of undernutrition in Chenchu population was comparable with other tribal and rural counterparts in Andhra Pradesh, however, the crude death rate (11.7/1000) was higher among the Chenchus. Steps may be taken to promote consumption of balanced diet and utilization of optimal healthcare facilities to control morbidity and mortality.

Diagnostic value of GP73 in alcoholic liver disease / 国际检验医学杂志

Objective To investigate diagnostic value of GP73 in alcoholic disease .Methods GP73 was measured by ELISA in 44 alcoholic fatty liver ,43 alcoholic hepatitis ,32 alcoholic cirrhosis ,67 non‐alcoholic fatty liver patients and 120 healthy control per‐sons .Meanwhile ALT ,AST ,ALP ,GGT ,Alb ,TBil ,AFP were measured .Results GP73 of alcoholic fatty liver ,alcoholic hepatitis , alcoholic cirrhosis ,non‐alcoholic fatty liver patients and healthy control group were (84 .22 ± 26 .22) ,(157 .98 ± 39 .71) ,(201 .23 ± 61 .14) ,(62 ± 14 .02) ,(47 .08 ± 22 .75)ng/mL respectively .The GP73 differences between patients and healthy control group had statistical significance(P<0 .05) .Before and after therapy of alcoholic hepatitis and alcoholic cirrhosis patients had statistical signif‐icance(P<0 .05) .Sensitivity of diagnostic value of GP73 in ALD was 71 .4% and specification was 95 .2% .Conclusion Serum GP73 elevates in types of alcoholic liver disease and show significant diagnostic value .Decrease of GP73 could be applied to assess treatment of alcoholic hepatitis and alcoholic cirrhosis .

Two Cases of Retinal Hemorrhage in Alcoholic Cirrhosis

PURPOSE: To report 2 cases of retinal hemorrhage due to anemia and thrombocytopenia in patients with alcoholic cirrhosis. CASE SUMMARY: (Case 1) A 45-year-old female with alcoholic cirrhosis who was treated in the gastroenterology department presented with reduced vision in both eyes. Fundus examination showed multiple preretinal and subretinal hemorrhages with macular involvement in both eyes. Hematological findings revealed severe anemia and thrombocytopenia. One month after the transfusion treatment her visual acuity was improved and retinal hemorrhages resolved. (Case 2) A 47-year-old male presented with painless loss of vision in the left eye 3 days after orthotopic liver transplantation for the treatment of alcoholic cirrhosis. Fundus examination showed preretinal hemorrhages in both eyes with macular involvement in the left eye. During the transplantation, hematological findings revealed severe anemia and thrombocytopenia. Three months after the transfusion treatment his visual acuity was improved and retinal hemorrhages nearly completely resolved. CONCLUSIONS: Hematological abnormalities due to alcoholic cirrhosis can cause retinal hemorrhage. In the present cases the retinal hemorrhages were resorbed and the visual acuity recovered.

Manifestaciones dermatológicas de las enfermedades hepáticas: un enfoque para el médico general / Dermatological manifestations of liver diseases: an approach for the general physician

Las enfermedades hepáticas tienen manifestaciones cutáneas hasta en el 15% al 20% de los casos. Pueden ser muy variadas y ninguna de ellas es patognomónica; sin embargo, sureconocimiento puede ser la base para el inicio de estudios, así como para la primera aproximación hacia la etiología de la hepatopatía. En este artículo se describen las principales manifestaciones cutáneas de las enfermedades hepáticas incluyendo la ictericia, las telangiectasias, los angiomas en araña, el eritema palmar, los xantomas y los xantelasmas, entre otras.

Liver diseases have cutaneous manifestations in up to 15% to 20% of the cases. There are numerous and none of them is pathognomonic. However, its recognition may be the basis for the initiation of studies and be the first approach to the etiology of liver disease. In the present article the main cutaneous manifestations of liver disease are described, including jaundice, telangiectasias, spider angiomas, palmar erythema, xanthomas and xanthelasmas, among others.

A Case of Spontaneous Hemoperitoneum due to Gastroepiploic Vein Rupture in Alcoholic Cirrhosis / 대한간학회지

Portal hypertension often leads to the development of several collateral vessels that shunt blood flow from the portal to the systemic circulation. The rupture of intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. If the patient is hemodynamically unstable due to massive intra-abdominal bleeding, exploratory laparotomy should be performed on the patient. There are several reported cases of intra-abdominal variceal bleeding such as paraumbilical varix, the varix from the small intestine and proximal colon etc. Spontaneous hemoperitoneum caused by the rupture of gastroepiploic vein varix, however, has not been reported in Korea, to the best of our knowledge. We will discuss a patient with portal hypertension due to liver cirrhosis who presented with acute intra-abdominal bleeding. During the laparotomy, he was found to have a rupture of the gastroepiploic vein. The vessel was ligated, and the patient recovered uneventfully by operative variceal ligation.

The Association Between Genetic Polymorphisms of the Ethanol-metabolizing Enzymes and Susceptibility to Alcoholic Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: There is considerable variance in individual susceptibility to hepato-toxic effects of ethanol as evidenced by the finding that only about 10-20% of alcoholics develop alcoholic liver cirrhosis. The aims of this study were, 1) to get the data on the genetic polymorphisms of three major ethanol-metabolizing enzymes (ADH, CYP2E1, ALDH) in normal Korean adults, and to search for the specific genotypes influencing alcohol drinking behavior by the comparison of allele frequencies between healthy control group and heavy drinker group with or without liver disease, 2) to investigate the influence of the genetic polymorphisms of these enzymes on the susceptibility to alcoholic liver disease by the comparison of allele frequencies between heavy drinker group without liver disease and alcoholic liver cirrhosis group. METHODS: Healthy control group included 53 healthy males in military service without evidence of liver disease or alcoholism. Heavy drinker group without liver cirrhosis included 29 males who had been drinking 80g or more of alcohol daily for more than ten years but did not have any clinical evidence of liver disease. Alcoholic cirrhosis group included 43 male patients who had drunk 80g or more of alcohol daily for more than ten years and had clinical evidences of overt cirrhosis. Subjects with hepatitis B surface antigen or anti-hepatitis C antibody were excluded. Genotypes of the three enzymes were determined by PCR (polymerase chain reaction) and restriction fragment length polymorphism (RFLP) with genomic DNAs extracted from peripheral leukocytes. RESULTS: 1) In healthy Korean males, allele frequency of ADH22, ADH31, CYP2E1 c2 and ALDH22 was 81%, 94%, 30% and 14%, respectively. 2) The absence of ALDH22 or CYP2E1 c2 allele were significant risk factors for being a heavy drinker (odds ratio,' 0.09, 0.42, respectively). 3) Although it was not associated with the polymorphism of each ethanol-metabolizing enzymes, the susceptibility to alcoholic liver cirrhosis was significantly associated with combined genotypes of ADH2(22) & ADH3(1+1)& CYP2E1 B or C. COMCLUSION: Genetic polymorphisms of ethanol-metabolizing enzyrnes are significantly associated with the suseptability to alcoholic liver disease as well as alcohol drinking behavior.

Liver Cirrhosis: Etiological diagnosis and morphological characteristics of 369 biopsy-proven cases

To pursue a desirable format for the pathological diagnosis of liver cirrhosis, the authors attempted to classify 369 biopsy-proven cirrhosis on the basis of etiology and made effort to find out the morphological characteristics of each category. About 735 of total cases were HBsAg seropositive postnecrotic cirrhosis. Alcholic cirrhosis ws the second most frequent type, although accounted only 6.8%. In about 15%, the etiology was not known. Excluding the congenital biliary atresia, chronic biliary obstruction appeared to be a rare cause of cirrhosis among these biopsied cases. Of the HBsAg positive postnecrotic cirrhosis, the eAg seropositive cases tended to be micronodular and to show a higher necroinflammatory activity, in contrast to eAg seronegative cases and those complicated by hepatocellular carcinoma (HCC), suggesting that the loss of eAg is followed by a decrease of the destructive activity, active regeneration of hepatocytes and finally the development of HCC. alcoholic cirrhosis was micronodular in 64% and revealed histologic evidences of alcoholic liver disease in most cases. The results indicate that etiological diagnosis can be made in most cases of cirrhosis by the morphological characteristics and the precise clinical informations, including those on the NANB virus and the inborn error of metabolism, and that the pathological diagnosis should be more comprehensive, implicating the etiology, the nodular size and the necroinflammatory activity.

Histologic Pattern of Alcoholic Liver Disease in Korea

To elucidate the histologic pattern of alcoholic liver disease (ALD) in Korea, liver biopsies from 173 chronic alcoholics with clinical liver diseases were classified according to the pathologic parameters. One hundred and seventeen cases, the sum of 91 of 116 serum HBsAg negative and 26 of 57 HBsAg positive patients, had the histologic evidence of ALD. Fatty change(23.9%), alcoholic fibrosis (AF)(23.1%) and cirrhosis (23.1%), comprised the three major ALDs, and only 8.5% of cases fit the criteria of alcoholic hepatitis. Chronic sclerosing hyaline disease (CSHD), chronic active alcoholic hepatitis (CAAH) and AF, where non-cirrhotic fibrosis is the predominant change, comprised 44.5% of ALD. Both features of ALD and HBV liver disease (HBV-LD) were found in 17 cases that included 8 AF and 7 cirrhosis. These 17 patients tended to consume less alcohol than patients with other types of pure ALD except alcoholic heaptitis. Patients with the serum HBsAg positive ALD (37.4years) were about 8 years younger than those with the serum HBsAg negative ALD (45.1years). More or less fatty change and foamy degeneration were seen in 77.4% and 31.6% of ALD respectively. Mallory bodies, megamitochondria, iron deposition and perihepatocellular fibrosis were found in 20.5%, 29.9%, 42.7% and 77.8%, respectively. These findings indicate that non-cirrhotic chronic ALD such as CSHD, CAAH and AF are the important histologic patterns of ALD in Korea, and that chronic alcohol consumption and HBV may act synergistically in developing liver disease.