Continued Alcohol Intake Research Articles

AYURVEDIC MANAGEMENT IN HEPATITIS A W.S.R TO YAKRUTSHOTHA – A CASE STUDY

Hepatitis is a life-threatening liver infection caused by a viral infection or non-infectious causes like continuous alcohol intake, toxicity, overdose of NSAIDs, and several metabolic disorders. Based on clinical features, hepatitis A can be correlated to Yakrutshotha caused by the vitiation of Raktadhātu (blood tissue) along with Kapha dosa. Ayurvedic treatment regimens were given in the management of hepatitis A (Yakrut shotha) for 30 days. In this case, significant improvements were monitored based on signs and symptoms and the value of objective parameters.

Impact of Changes in Lifestyle and Psychological Factors on the Incidence of Metabolic Syndrome after the Great East Japan Earthquake: Follow-up of the Fukushima Health Management Survey.

The Fukushima Daiichi Nuclear Power Plant accident caused lifestyle changes and psychological distress in residents living near the plant. This study clarified the associations between changes in residents' lifestyles and psychological factors with the onset of metabolic syndrome (METs) after the accident. This longitudinal study included 10,373 residents who underwent the Comprehensive Health Check and Mental Health and Lifestyle Survey in Fiscal Year (FY) 2013. Follow-up surveys were conducted between FY 2014 and FY 2017. Lifestyle changes and the METs incidence were evaluated using a logistic regression model. METs developed in 14.0% of subjects. In addition to metabolic factors, such as the body mass index, hypertension, dyslipidemia, and diabetes mellitus, there were differences in physical activity, fast walking, eating fast, eating habits before bedtime, skipping breakfast, current smoking, and alcohol intake between subjects with and without new-onset METs. Eating fast, current smoking, and drinking alcohol were positively associated with new-onset METs, whereas starting physical activity and fast walking were inversely associated with new-onset METs. Disaster-related lifestyle changes, such as eating fast, starting to smoke, and continued alcohol intake, were risk factors for new-onset METs after the Fukushima Daiichi Nuclear Power Plant accident.

Weight Loss Improves Liver Dysfunction and Dipstick Proteinuria in Obesity: The Japan Specific Health Checkups Study.

Obesity and inappropriate lifestyle is the major risk factors for liver dysfunction and proteinuria. Nevertheless, previous studies have not described the differential impacts of body weight changes and lifestyle modification on already developed liver dysfunction and proteinuria. The original cohort was 933,490 individuals from the Japanese general population. In this investigation, we included 36,256 obese individuals with elevated levels of aspartate aminotransferase and/or alanine aminotransferase (≥31 IU/L) or positive proteinuria (+/- or more) in both the first and second years. Outcomes were the first normalization of these data defined as improvement in liver dysfunction and proteinuria. Times to outcomes were assessed using the Cox proportional hazards modeling for -1 kg/m2/year change in body mass index (BMI) changes in exercise and alcohol intake. The multivariable-adjusted hazard ratio (HR) for incident improvement in liver dysfunction with BMI change -1.0 kg/m2/year was 1.07 (95% confidence interval [CI] 1.05-1.09) in obesity and that with improved proteinuria was 1.04 (95%CI 1.02-1.07). Compared to subjects without exercise habits, subjects who gained exercise habits exhibited a higher rate of improvement in liver dysfunction (HR 1.08; 95%CI 1.01-1.15) but not in proteinuria (HR 0.98; 95%CI 0.88-1.08). Compared to subjects with continuous alcohol intake habits, subjects who quit alcohol intake also showed a higher rate of improvement in liver dysfunction (HR 1.20; 95%CI 1.09-1.32). This study suggested that weight loss greater than 1 kg/m2/year improves liver dysfunction and dipstick proteinuria in obesity. Particularly, liver dysfunction can be remedied by acquiring an exercise habit and quitting alcohol intake.

Urolithin A attenuates severity of chronic pancreatitis associated with continued alcohol intake by inhibiting PI3K/AKT/mTOR signaling.

Heavy alcohol consumption is the dominant risk factor for chronic pancreatitis (CP); however, treatment and prevention strategies for alcoholic chronic pancreatitis (ACP) remains limited. The present study demonstrates that ACP induction in C57BL/6 mice causes significant acinar cell injury, pancreatic stellate cell (PSC) activation, exocrine function insufficiency, and an increased fibroinflammatory response when compared with alcohol or CP alone. Although the withdrawal of alcohol during ACP recovery led to reversion of pancreatic damage, continued alcohol consumption with established ACP perpetuated pancreatic injury. In addition, phosphokinase array and Western blot analysis of ACP-induced mice pancreata revealed activation of the phosphatidylinositol 3 kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) and cyclic AMP response element binding protein (CREB) signaling pathways possibly orchestrating the fibroinflammatory program of ACP pathogenesis. Mice treated with urolithin A (Uro A, a gut-derived microbial metabolite) in the setting of ACP with continued alcohol intake (during the recovery period) showed suppression of AKT and P70S6K activation, and acinar damage was significantly reduced with a parallel reduction in pancreas-infiltrating macrophages and proinflammatory cytokine accumulation. These results collectively provide mechanistic insight into the impact of Uro A on attenuation of ACP severity through suppression of PI3K/AKT/mTOR signaling pathways and can be a useful therapeutic approach in patients with ACP with continuous alcohol intake.NEW & NOTEWORTHY Our novel findings presented here demonstrate the utility of Uro A as an effective therapeutic agent in attenuating alcoholic chronic pancreatitis (ACP) severity with alcohol continuation after established disease, through suppression of the PI3K/AKT/mTOR signaling pathway.

Combining Metabolomics and Interpretable Machine Learning to Reveal Plasma Metabolic Profiling and Biological Correlates of Alcohol-Dependent Inpatients: What About Tryptophan Metabolism Regulation?

Alcohol dependence (AD) is a condition of alcohol use disorder in which the drinkers frequently develop emotional symptoms associated with a continuous alcohol intake. AD characterized by metabolic disturbances can be quantitatively analyzed by metabolomics to identify the alterations in metabolic pathways. This study aimed to: i) compare the plasma metabolic profiling between healthy and AD-diagnosed individuals to reveal the altered metabolic profiles in AD, and ii) identify potential biological correlates of alcohol-dependent inpatients based on metabolomics and interpretable machine learning. Plasma samples were obtained from healthy (n = 42) and AD-diagnosed individuals (n = 43). The plasma metabolic differences between them were investigated using liquid chromatography-tandem mass spectrometry (AB SCIEX® QTRAP 4500 system) in different electrospray ionization modes with scheduled multiple reaction monitoring scans. In total, 59 and 52 compounds were semi-quantitatively measured in positive and negative ionization modes, respectively. In addition, 39 metabolites were identified as important variables to contribute to the classifications using an orthogonal partial least squares-discriminant analysis (OPLS-DA) (VIP > 1) and also significantly different between healthy and AD-diagnosed individuals using univariate analysis (p-value < 0.05 and false discovery rate < 0.05). Among the identified metabolites, indole-3-carboxylic acid, quinolinic acid, hydroxy-tryptophan, and serotonin were involved in the tryptophan metabolism along the indole, kynurenine, and serotonin pathways. Metabolic pathway analysis revealed significant changes or imbalances in alanine, aspartate, glutamate metabolism, which was possibly the main altered pathway related to AD. Tryptophan metabolism interactively influenced other metabolic pathways, such as nicotinate and nicotinamide metabolism. Furthermore, among the OPLS-DA-identified metabolites, normetanephrine and ascorbic acid were demonstrated as suitable biological correlates of AD inpatients from our model using an interpretable, supervised decision tree classifier algorithm. These findings indicate that the discriminatory metabolic profiles between healthy and AD-diagnosed individuals may benefit researchers in illustrating the underlying molecular mechanisms of AD. This study also highlights the approach of combining metabolomics and interpretable machine learning as a valuable tool to uncover potential biological correlates. Future studies should focus on the global analysis of the possible roles of these differential metabolites and disordered metabolic pathways in the pathophysiology of AD.

Outcomes of excessive alcohol drinkers without baseline evidence of chronic liver disease after 15 years follow-up: Heavy burden of cancer and liver disease mortality.

Most long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline. A cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018. At baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01-1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01-1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer-mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69-74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively. Long-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.

Alcohol-related head and neck cancer: Summary of the literature.

Alcohol drinking is a risk factor for the development of head-and-neck malignancies, including oral, pharyngeal, and laryngeal cancers, and coupled with tobacco use, accounts for 75% of oral cancers. We summarized the literature on alcohol-related head and neck cancer (HNC) and identified gaps that represent areas for future investigation. Research indicates that alcohol consumption has not only been linked to the development of primary HNCs, but also to secondary cancers with continued alcohol intake, cancer recurrences, and other poor health outcomes. Given this evidence, several organizations have called for reduction or avoidance of alcohol, particularly in HNC survivors. Despite these strong recommendations, evidence suggests that HNC survivors continue to use alcohol. There is a need to forge collaborations among clinicians, researchers, and social workers, to address this problem of alcohol consumption in the growing population of HNC survivors.

Hospital admissions and mortality in the 15 years after a first-time hospital contact with an alcohol problem: a prospective cohort study using the entire Danish population.

Potential benefits of preventing continued alcohol intake in individuals presenting at the hospital with an alcohol problem can be highlighted by studying their excess risk of subsequent morbidity and mortality. All Danish residents with a first-time hospital contact with alcohol problems (intoxication, harmful use or dependence) in 1998-2002 were followed through 2012 using healthcare registries. We compared their cause-specific rates of hospital admission and mortality to the expected rates derived from the general population by calculating standardized incidence rate ratios. The 26 716 men and 12 169 women who were hospitalized with alcohol problems (median age 44 years) had more than 10 times the rate of subsequent admission to psychiatric departments and three times the rate of subsequent admission to somatic departments compared with the general population. In particular, the hospital admission rates for gastroenterological disease and injuries were high. The cumulative all-cause 10-year mortality risk was 29% [95% confidence interval (CI), 28-30] in men and 26% (95% CI, 24-27) in women with alcohol problems. The ratios of observed to expected death rate for all-cause mortality were 4.0 (95%CI, 3.8-4.1) in men and 4.3 (95%CI, 4.0-4.7) in women and, for causes of death fully attributable to alcohol, 16 (95%CI, 15-17) in men and 33 (95%CI, 29-38) in women. Individuals hospitalized with alcohol problems have much higher rates of subsequent alcohol-related hospital admission and mortality than the general population. Increased focus on preventing continued alcohol consumption in these individuals may reduce their subsequent morbidity and mortality.

Serum Urea at Admission Is a Predictor of Mortality in Patients With Acute on Chronic Liver Failure

Introduction: Occurrence of acute kidney injury [AKI] in Acute on chronic liver failure (ACLF) negatively impacts their survival. Only elevated serum creatinine is used to assess AKI and predict survival in ACLF. There is little data on impact of serum urea on outcome; serum urea values are ignored for prognostication. We performed a prospective study to evaluate the impact of serum urea on survival in ACLF. Methods: This study was conducted in ACLF patients hospitalised in Gastroenterology Department of SCB Medical College in India from October 2016 to March 2018. Demographic, clinical, laboratory parameters were recorded and outcome compared in patients with special reference to admission serum urea level. Results: Consecutive decompensated cirrhosis (DC) patients (n=439) were screened for ACLF as per The Asian Pacific Association for the Study of the Liver (APASL) criteria. 113 (25.7%) of them had ACLF. Out of the 113 ACLF cases, 78 (69%) had AKI as per AKIN (Acute Kidney Injury Network) criteria. Alcohol was the commonest underlying cause of CLD (74.3%) and continued alcohol intake (61%) was the commonest precipitant of ACLF. On multivariate analysis, admission serum urea (not serum creatinine) was found to be an independent predictor of mortality in ACLF both at 28 days; p=.001, AHR 1.014(1.006-1.023) and 90 days; p<.001, AHR 1.016(1.008-1.024) and also in ACLF patients with AKI, both at 28 days; p=0.002, AHR 1.014 (1.005-1.023) and 90 days; p=.001, AHR 1.016 (1.007-1.025). The discrimination ability between survivors and deceased is higher with serum urea [AUROC 28 days; 0.772 (0.686-0.859), 90 days; 0.780(0.695-0.866); 95% CI] than with serum creatinine [AUROC 28 days; 0.760(0.669-0.850), 90 days; 0.768(0.680-0.856); 95% CI]. Conclusion: In our institution, about one fourth of decompensated cirrhotic patients had ACLF, and more than two thirds of them were associated with AKI. Admission serum urea was found to be a better predictor of mortality than serum creatinine. Hence serum creatinine can be replaced by serum urea as a better predictor of mortality [both 28 and 90 days' mortality] in ACLF patients.

Difficult to Swallow: A Case of Dysphagia Lusoria

The term Dysphagia Lusoria, which stands for “freak of nature,” was coined by Bayford in 1794, which he used to describe dysphagia in an elderly woman who died of esophageal obstruction and subsequent weight loss as a result of the aberrant right subclavian retro-esophageal artery. CASE REPORT: A 65-year-old male presented to the ED with a nonproductive cough for one month and difficulty swallowing solids for one week. The patient stated the cough was initially intermittent and dry in nature and progressed in persistency with a noticeable dysphagia to solid foods. He said that he had lost about 10 pounds since the onset of solid food dysphagia. He denied progression of dysphagia to liquid. His past medical history was significant for asbestos exposure and he had a 5 pack year smoking history with continued episodic alcohol intake of 12 beers per week. The patient was subsequently admitted to the hospital and an esophagram was performed which revealed an aberrant right subclavian artery impression in the posterior wall of esophagus. General surgery was consulted and an EGD was performed that showed gastritis and duodenitis and the patient was started on a PPI and sucralfate. Vascular surgery was also consulted for the suspected aberrant right subclavian and recommended a CTA chest which was consistent with aberrant right subclavian artery, as well as calcified pleural plaques. No surgical intervention was recommended. The patient was counseled on smoking and alcohol abuse and educated about his condition causing dysphagia. DISCUSSION: In the majority of cases, dysphagia lusoria is asymptomatic or presents with mild dysphagia. A small minority of adult patients, however, have a severe symptoms leading to an inability to swallow and subsequent malnutrition. Hence, the coined name dysphagia lusoria. In children, it can present as stridor and repeated chest infections due to tracheal softening, whereas in adults, it presents mainly with difficulty in swallowing and in severe cases, failure to thrive. Due to nonspecificity of the symptoms and nondiagnostic endoscopy in most of the cases, the diagnosis of dysphagia lusoria can be challenging. For mild to moderate symptomology, lifestyle modifications including changes in diet and reassurance are recommended. More severe cases require surgical ntervention. Dysphagia lusoria, although a rare cause of symptomatic dysphagia, is a diagnosis that should be considered due to its difficulty of confirmation.Figure: Barium swallow showing impression in the posterior wall of upper thoracic esophagus at cervicothoracic junction area correlating with vascular impression from the aberrant right subclavian artery.Figure: Sagittal view of CTA scan showing aberrant subclavian artery compressing the esophagus.Figure: Axial view of CTA scan showing aberrant subclavian artery compressing the esophagus.

Effect of ALDH2 Genetic Polymorphism on the Adaptive Change in Alcohol Metabolism Due to Continuous Moderate Alcohol Consumption in Humans

Few studies have assessed the difference in adaptive changes of alcohol metabolism in the case of chronic alcohol consumption pertaining to the genetic polymorphism of aldehyde dehydrogenase 2 (ALDH2) in humans. To evaluate the influences of ALDH2 genotypes on changes in alcohol metabolism due to continuous alcohol intake, we conducted an intervention study by setting a continuous drinking period between two abstinence periods. The subjects in this study comprised 20 - 25-year-old males, including 15 males carrying ALDH2*1/*1 and 16 carrying ALDH2*1/*2 genotypes. Following the abstinence period of 4 weeks (from day 1 to day 28), all subjects drank commercially available beer (500 ml) every evening for 6 weeks (from day 30 to day 71) and subsequently abstained from drinking again for 4 weeks (from day 73 to day 100). The next morning, after the end of each period, drinking tests (DTs) were performed on each subject (DT1 on day 29, DT2 on day 72, and DT3 on day 101) to examine alcohol metabolism. The subjects drank shochu (a distilled alcoholic beverage), with an ethanol dose of 0.32 g/kg, within 20 minutes after overnight fasting. The alcohol elimination rate in subjects with ALDH2*1/*1 genotype was significantly higher during DT2 after the drinking period as compared with those at both DT1 and DT3 after the abstinence periods, whereas the elimination rate in subjects with ALDH2*1/*2 genotype did not change significantly during 3 DTs. However, blood acetaldehyde levels significantly decreased in subjects with both ALDH2 genotypes during DT2 as compared with those during DT1. The physiological subjective responses to alcohol also significantly decreased during DT2 in subjects with ALDH2*1/*2 genotype. Moreover, serum lipids, gamma-glutamyltransferase (GGT), and uric acid concentrations also varied between subjects with different ALDH2 genotypes due to continuous drinking. These results suggested that ALDH2 polymorphism modified adaptive changes in alcohol metabolism and physiological responses to continuous moderate alcohol consumption.

Pharmacological blockade of corticotropin-releasing hormone receptor 1 (CRH1R) reduces voluntary consumption of high alcohol concentrations in non-dependent Wistar rats

BackgroundA dysregulation of the corticotropin-releasing hormone (CRH) system has been implicated in the development of excessive alcohol consumption and dependence. The aim of the present study was to evaluate whether the CRH system is also recruited when non-dependent Wistar rats escalate to high alcohol intake in the intermittent (alternate days) model of drinking. MethodsWe compared intermittent and continuous access to 20% (v/v) alcohol in a two-bottle free choice drinking paradigm. Following a total of twenty 24-hour exposures for every experimental group, we assessed signs of alcohol withdrawal, including anxiety-like behavior and sensitivity to stress. The selective CRH1 receptor (CRH1R) antagonist antalarmin (0, 10, 20mg/kg, i.p.) was tested on alcohol consumption. ResultsIntermittent access to 20% alcohol led non-selected Wistar rats to escalate their voluntary intake to a high and stable level, whereas continuously exposed animals maintained a lower consumption. These groups did not differ in physical withdrawal signs. In addition, no differences were found when anxiogenic-like behavior was studied, neither under basal conditions or following restraint stress. Nevertheless, sensitivity to the treatment with the CRH1R antalarmin was observed since a reduction of 20% alcohol intake was found in both groups of animals regardless of the regimen of alcohol exposure. In addition, antalarmin was effective when injected to animals exposed to intermittent 10% (v/v) alcohol whereas it failed to suppress 10% continuous alcohol intake. ConclusionsPharmacological blockade of CRH1R reduced alcohol drinking when sustained high levels of intake were achieved suggesting that the CRH system plays a key role when high doses of ethanol are consumed by non-dependent subjects. This supports the notion that CRH system not only maintains the dependent state but also engages the transition to dependence.

Withdrawal of alcohol promotes regression while continued alcohol intake promotes persistence of LPS-induced pancreatic injury in alcohol-fed rats

Background and aimsAdministration of repeated lipopolysaccharide (LPS) injections in alcohol-fed rats leads to significant pancreatic injury including fibrosis. However, it remains unknown whether alcoholic (chronic) pancreatitis has the potential to...

Total Hip Arthroplasty for Alcoholic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head in the setting of alcohol abuse is a potential important cause of symptomatic hip disease in young patients. All cases of uncemented primary total hip arthroplasty (THA) with a primary operative diagnosis of osteonecrosis of the femoral head secondary to alcohol abuse treated at our institution from January 1990 to February 2002 were identified. Twenty-three patients with 28 hips were identified; all patients had advanced disease (subchondral collapse) that was unresponsive to conservative treatment modalities. Within 5 years of index THA, 2 patients were lost to follow-up, and 2 patients died from causes unrelated to their surgery. The remaining 19 patients underwent 24 THAs. Unilateral THA was performed in 14 patients, and bilateral THA was performed in 5 patients. Seventeen men and 2 women with an average age of 41.8 years (range, 30-59 years) at the time of THA were included in the study. The average duration to clinical follow-up was 7.6 years. There was significant improvement in hip pain and hip function scores. Seven THAs were revised at a mean 6.7 years following index THA. Five- and 10-year implant survivorship free of revision was 96% and 64%, respectively (Kaplan-Meier Survivorship Analysis). The continued use of alcohol was associated with a slightly increased risk of failure (61% implant survivorship at 10 years in those with continued alcohol intake vs 75% 10-year survivorship in those without).

Taurine supplementation improves the utilization of sulfur-containing amino acids in rats continually administrated alcohol

The main purpose of this study was to evaluate changes in brain sulfur-containing amino acid (SCAA) metabolism to determine whether taurine intervened under continuous alcohol intake. We fed 80 male Sprague–Dawley rats 30% alcohol-containing water for 4 weeks. Eighty animals were divided into two groups (with or without 2 g/kg body weight taurine supplementation), and five were killed every week in each group for monitoring SCAA changes in the brain, liver, kidneys and heart. Results indicated that the plasma alcohol concentration increased from Weeks 1–4; however, animals with taurine supplementation showed a lower plasma concentration of ethanol in Week 2. As to SCAA concentrations, cysteine and taurine were both lower after a week of alcohol ingestion in the brain and plasma; the same declining trend was shown in the liver in Week 2. In contrast, plasma and hepatic concentrations of homocysteine were elevated in Week 2, and the plasma S-adenosylmethionine (SAM)/ S-adenosylhomocysteine (SAH) ratio also decreased in Week 1. Furthermore, the key cofactor of transsulfuration, pyridoxal-5′-phosphate, significantly declined in the plasma after a week of the ethanol intervention, whereas an increase was observed in brain tissue. Under taurine supplementation, some recoveries were shown by delaying taurine depletion to Week 2, increasing the SAM/SAH ratio and elevating plasma and brain levels of vitamin B 6 in Week 2. In conclusion, daily consumption of 30% alcohol interfered with SCAA metabolism, thus decreasing taurine's role in neurotransmission. The possible mechanism involved might be that ethanol interrupts the production of cysteine, which is the upstream SCAA of taurine, thus decreasing the homocysteine level. Additionally, taurine supplementation delayed this process.

T1894 Abstinence Promotes Regression While Continued Alcohol Intake Promotes Persistence of LPS-Induced Pancreatic Injury in Alcohol-Fed Rats

T1894 Abstinence Promotes Regression While Continued Alcohol Intake Promotes Persistence of LPS-Induced Pancreatic Injury in Alcohol-Fed Rats

Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m(2)) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 +/- 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 +/- 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 +/- 1.7 vs 18.1 +/- 1.8 kg/m(2), P = .001; 16.7 +/- 1.6 vs 18.2 +/- 1.6 kg/m(2), P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

Continuous, but Not Occasional, Oral Ethanol Intake Reduces the Success of Intraportal Transplanted Islets of Langerhans: An Experimental Study

Background Islet transplantation is gradually gaining acceptance for the treatment of type 1 diabetes mellitus. One of the unknown questions is alcohol intake; we have prohibited alcohol intake after islet transplantation although there is no solid evidence to support this. Materials and Methods In this study, we employed a mouse model to determine the effect of oral ethanol intake on transplanted islets. Either 500 or 150 islets were infused selectively into the right liver lobe of chemically induced diabetic mice. After transplantation, mice were orally administered either water (as a control) or various concentrations of ethanol for 14 consecutive days occasionally (once per day) or continuously (all intake was alcohol). Blood glucose levels were monitored and oral glucose tolerance tests (OGTT) performed. Results After 500 islets had been transplanted, all mice were cured from diabetes, but the continuous alcohol intake group showed significantly prolonged time to diabetes reversal and significantly lower glucose clearance rates by OGTT compared with the control group. After 150 islet transplantations, the diabetes cure rate in the continuous alcohol intake group was significantly lower than the control group (continuous alcohol vs control: 3/8 vs 11/12, P < .05). However, the occasional alcohol intake group showed no difference from the control group, even with as few as 150 islets transplanted per mouse. Conclusion The present results demonstrated that continuous but not occasional alcohol intake reduced the success of intraportal islet transplantation.

Effect of Bromhexine Hydrochloride Therapy for Alcoholic Chronic Pancreatitis

Abstinence is a prerequisite for the treatment of alcoholic chronic pancreatitis, but there are patients who have repeated attacks because of their inability to abstain and the consequent congestive effects of the continued alcohol intake on pancreatic juice. Bromhexine hydrochloride, a bronchial mucolytic, has an affinity for acinar cells and causes them to secrete pancreatic juice of low viscosity. Twelve patients with alcoholic chronic pancreatitis, who were unable to abstain from drinking, were administered bromhexine hydrochloride for 6 months to assess its therapeutic efficacy. Of 12 patients administered bromhexine, 8 (67%) reported symptomatic improvement, and all patients showed improvement in the levels of pancreatic enzymes. Pancreatic exocrine function also tended to improve, but no improvement of pancreatic endocrine function was detected. Although none of the pancreatic stones present in some patients disappeared, a protein plug present in one patient disappeared, accompanied by improvement in the irregular outline of the lumen of the main pancreatic duct. Bromhexine hydrochloride may be a new for the morbidity of chronic pancreatitis, in which there is increased viscosity of the pancreatic juice and formation of a protein plug.

Results of 100 duodenum-preserving pancreatic head resections for chronic pancreatitis: comparison of FREY- and BEGER procedure

There is controversial discussion on the optimal type of surgery in patients with chronic pancreatitis (CP). Duodenum-preserving head resections (DPPHR) in the variations by FREY or BEGER may provide similar long-term outcomes but data are rare. We analyzed perioperative outcomes after 100 DPPHR and long-term results in 65 of those patients. Methods: Since 1994 100 DPPHR (55 FREY, 45 BEGER) were performed for CP. The indications to perform a FREY- or a BEGER-procedure were dependent on the presence of local organ complications like biliary or duodenal stenosis. Indications for surgery were recurrent episodes of CP with pain (91%), jaundice (21%) or duodenal obstruction (11%). 85% had an inflammatory mass of the pancreatic head, 37% had regional or generalized portal hypertension. Long-term outcome was available up to now in 65 patients (35 FREY-, 30 BEGER-procedure) with a median follow-up of 31 months. Results: Median operative time (370 mins) was longer for BEGER-procedures (p<0.01). Median LOS (13 days) and blood substitution (2 units) were similar in both groups. Perioperative complications occurred in 27% after FREY- and 42% after BEGER-procedure (p=0.08), surgical complications in 18% (FREY) and 31% (BEGER; p=0.1). Operative mortality was 1%. Until last follow-up 28% of all patients developed de novo exocrine and 16% de novo endocrine insufficiency. Median weight gain was 3kg. 63% had no abdominal pain at all, and 15% had pain less frequently than once per month. 93% of the patients judged the success of surgery as very good or good. All follow-up parameters showed no statistical differences between the FREY- and BEGER-group. Patients with longstanding CP had in overall a higher incidence of exocrine and endocrine insufficiency at end of follow-up. Continuous alcohol intake negatively influenced the outcome. Conclusions: Both types of DPPHR control complications of CP in the majority of patients with good medium- to long-term results. Due to shorter operative time and slightly fewer complications the FREY-procedure can be proposed dependent on the local organ complications. The long-term outcome is mainly influenced by long-standing CP itself and continuous alcohol intake.