Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver Function

• Published in: The American journal of gastroenterology Vol. 103; no. 7; pp. 1698 - 1706
• Main Authors: Lucey, Michael R., Connor, Jason T., Boyer, Thomas D., Henderson, J. Michael, Rikkers, Layton F.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.07.2008; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Alcohol Drinking - mortality; Ascites - etiology; Biological and medical sciences; Esophageal and Gastric Varices - complications; Female; Follow-Up Studies; gamma-Glutamyltransferase - blood; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - complications; Hepatic Encephalopathy - etiology; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - enzymology; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Liver Cirrhosis, Alcoholic - enzymology; Liver Cirrhosis, Alcoholic - mortality; Liver Cirrhosis, Alcoholic - physiopathology; Liver Diseases, Alcoholic - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Surveys and Questionnaires; Consumption; Human; Cirrhosis; Liver function; Gastroenterology; Digestive diseases; Hepatic disease; Alcohol
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.1111/j.1572-0241.2008.01837.x

We investigated patterns of use of alcohol and its clinical effects among cirrhotic subjects who participated in a randomized clinical trial comparing the efficacy of transjugular intravenous portosystemic shunt and distal splenorenal shunt. There were 132 cirrhotic subjects, 78 with alcoholic liver disease (ALD), who were followed for a median of 49 months (range 2-93 months). Alcohol use was assessed by patient questionnaire, with corroboration by family members. Twenty-eight subjects (21%) were drinking at study entry and 60 subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking by ALD subjects was associated with a 153% increase in gamma-glutamyl transpeptidase (GGT) (P < 0.0001). The frequencies of death (46%vs 30%), ascites (33%vs 20%), encephalopathy (56%vs 42%), and variceal bleeding (11%vs 3%) were greater in the ALD group. In a Cox proportional hazards model only "ever heavy drinking" was associated with death (P= 0.0099), while recent heavy drinking increased the hazard of variceal hemorrhage dramatically (odds ratio 10.85). Whereas most cirrhotic subjects, alcoholic or not, did not drink during 5 yr of observation, heavy alcohol use occurred exclusively in ALD patients. Alcohol use by ALD subjects was associated with elevations in GGT and was linked to death and with rebleeding from shunt dysfunction.