Diagnosis Of Alcoholic Liver Disease Research Articles

Serendipity in Medicine-Elevated Immunoglobulin E Levels Associated with Excess Alcohol Consumption

Making a diagnosis of alcoholic liver disease is not always easy. There are problems in obtaining an accurate and reliable history of alcohol consumption. Laboratory findings and hepatic imaging studies are neither sensitive or specific, and newer test are being considered. Recently, a patient was admitted with possible alcoholic hepatitis. The first-year resident who admitted the patient mistakenly ordered a blood test for serum IgE. The result was a markedly elevated −6440 IU/mL. There was no evidence of parasitic infections, atopy or autoimmune disease nor was there any eosinophilia. A literature search showed that elevated IgE levels are associated with alcohol abuse. This association has been forgotten and does not appear in standard reference sources such as UptoDate or Harrison’s Principles of Internal Medicine. This judicious use of examining serum IgE levels may aid in the diagnosis of alcoholic hepatitis.

Pleural Effusion and Malnutrition Are Associated With Worse Early Outcomes After Liver Transplant.

Pulmonary complications after liver transplantation (LT) have previously been associated with longer hospital stays and ventilator time, and higher mortality. This study reports the outcomes for a specific pulmonary complication, pleural effusion, in LT recipients. Records from a single transplant center were analyzed retrospectively for all adult LT patients. Patients with documented pleural effusion by radiographic imaging within 30 days pre- or post-transplant were considered as cases. Outcomes included length of hospital stay, discharge disposition, hospital readmission, discharge with home oxygen, and 1-year survival. During the 4-year study period, 512 LTs were performed, with 107 patients (21%) developing a peri-transplant pleural effusion. In total, 49 patients (10%) had a pre-transplant effusion, 91 (18%) had a post-transplant effusion, and 32 (6%) had both. Characteristics associated with the presence of any pleural effusion included an increasing model for end-stage liver disease score, re-transplantation, diagnosis of alcoholic liver disease, low protein levels, and sarcopenia. Effusion patients had longer hospital stays (17 vs 9 days, P < .001) and higher likelihood of discharge to a care facility (48% vs 21%, P < .001). Ninety-day readmission occurred in 69% of effusion patients (vs 44%, P < .001). One-year patient survival with any effusion was 86% (vs 94%, P < .01). Overall, 21% of recipients developed a clinically significant peri-transplant pleural effusion. Pleural effusion was associated with worse outcomes for all clinical measures. Risk factors for the development of pleural effusion included higher MELD score (>20), re-transplantation, alcoholic liver disease, and poor nutrition status, including poor muscle mass.

A ratiometric hypochlorite-specific nanoprobe constructed by rationally designed AIE luminogen for fluorescence imaging of alcoholic liver disease

There is a lack of effective and friendly diagnostic technique for alcoholic liver disease (ALD). Fluorescence imaging, which has been widely applied in disease diagnostic ascribed to the merits of high sensitivity, excellent temporal resolution and minimal invasiveness, is probably a good candidate for ALD studying. Herein, by precise molecular optimization, an aggregation-induced emission (AIE) probe of TCPQ was designed to show bright near-infrared (NIR) emission centered at 680 nm, and selective response towards ClO− for ALD diagnosis. In comparison with PNQ, the started fluorophore constructed with ClO− oxidizable donor phenothiazine (PZ) and AIE active acceptor quinoline-malononitrile (QM), the emission wavelength and fluorescence quantum yield of TCPQ were 63 nm red-shifted and 2.3-fold enhanced after structural optimization. Once exposed to ClO−, the S atom in PZ donor of TCPQ could be oxidized to sulfoxide, leading to blue-shifted emission, which made TCPQ be suitable for ratiometirc imaging with high accuracy, while the such weak emissions of the other probes here in presence of ClO− made the ratiometric imaging impossible. After forming nanoparticles (NPs) with amphiphilic F-127, TCPQ NPs have successfully imaged the exogenous and endogenous ClO− fluctuations through the ratio between brightness of green channel and red channel, and have been further utilized to quantitatively evaluate the ClO− levels in four types of cells. The possibility of ClO− as a biomarker for ALD was confirmed in the cellular ALD model. Subsequently, TCPQ NPs were further applied in ALD diagnosis and pharmacodynamic evaluation of an anti-ALD drug in the mouse model.

The Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis.

Alcoholic hepatitis (AH) is characterized by acute symptomatic hepatitis associated with heavy alcohol use. This study was designed to assess the impact of metabolic syndrome on high-risk patients with AH with discriminant function (DF) score ≥ 32 and its effect on mortality. We searched the hospital database for ICD-9 diagnosis codes of acute AH, alcoholic liver cirrhosis, and alcoholic liver damage. The entire cohort was categorized into two groups: AH and AH with metabolic syndrome. The effect of metabolic syndrome on mortality was evaluated. Also, an exploratory analysis was used to create a novel risk measure score to assess mortality. A large proportion (75.5%) of the patients identified in the database who had been treated as AH had other etiologies and did not meet the American College of Gastroenterology (ACG)-defined diagnosis of acute AH, thus had been misdiagnosed as AH. Such patients were excluded from analysis. The mean body mass index (BMI), hemoglobin (Hb), hematocrit (HCT), and alcoholic liver disease/non-alcoholic fatty liver disease index (ANI) were significantly different between two groups (P < 0.05). The results of a univariate Cox regression model showed that age, BMI, white blood cells (WBCs), creatinine (Cr), international normalized ratio (INR), prothrombin time (PT), albumin levels, albumin < 3.5, total bilirubin, Na, Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), MELD ≥ 21, MELD ≥ 18, DF score, and DF ≥ 32 had a significant effect on mortality. Patients with a MELD greater than 21 had a hazard ratio (HR) (95% confidence interval (CI) of 5.81 (2.74 - 12.30) (P < 0.001). The adjusted Cox regression model results showed that age, Hb, Cr, INR, Na, MELD score, DF score, and metabolic syndrome were independently associated with high patient mortality. However, the increase in BMI and mean corpuscular volume (MCV) and sodium significantly reduced the risk of death. We found that a model including age, MELD ≥ 21, and albumin < 3.5 was the best model in identifying patient mortality. Our study showed that patients admitted with a diagnosis of alcoholic liver disease with metabolic syndrome had an increased mortality risk compared to patients without metabolic syndrome, in high-risk patients with DF ≥ 32 and MELD ≥ 21. A bivariate correlation analysis revealed that patients with AH with metabolic syndrome were more likely to have infection (43%) compared to AH (26%) with correlation coefficient of 0.176 (P = 0.03, CI: 0.018 - 1.0). In clinical practice, the diagnosis of AH is inaccurately applied. Metabolic syndrome significantly increases the mortality risk in high-risk AH. It signifies that the presence of features of metabolic syndrome modifies the behavior of AH in acute settings, warranting different therapeutic strategies. We propose that in defining AH, patients overlapping with metabolic syndrome may need to be excluded as their outcome is different with regard to risk of renal dysfunctions, infections and death.

Roles and correlations of TIM-3 and LAG-3 with cytokines and chemokines in alcoholic liver disease

BackgroundDysregulation of immune checkpoint regulators has been reported in alcoholic liver disease (ALD). This study was designed to assess the serum levels of cytokines and chemokines associated with ALD and uncover the possible disease correlations with the soluble TIM-3 and LAG-3. MethodsThe soluble TIM-3 and LAG-3 levels were measured by enzyme-linked immunoassay, and 14 cytokines and chemokines were measured using Luminex-based multiplex assay in 111 male ALD patients and 45 healthy controls (HCs). ResultsOur results showed that soluble TIM-3 was significantly increased (p < 0.001) while soluble LAG-3 was significantly decreased (p < 0.001) in ALD group compared to HCs. Among the 14 cytokines and chemokines assessed, granulocyte-colony stimulating factor (G-CSF) (p = 0.003) and interferon γ-induced protein (IP)-10 (p < 0.001) were significantly increased, while interleukin (IL)-4 (p = 0.005) and IL-12 (p40) (p = 0.001) were significantly decreased in the ALD group. Kaplan-Meier analysis showed that overall survival decreased in higher TIM-3 level individuals. ConclusionsOur results showed that TIM-3, LAG-3, and IP-10 appear to be important for clinical diagnosis of ALD and ALD severity and may represent potential therapeutic targets in ALD.

Efficacy of bile acid profiles in diagnosing and staging of alcoholic liver disease

Aim The diagnosis of alcoholic liver disease (ALD) is still a great challenge. Therefore, the purpose of this study is to identify and characterize new metabolomic biomarkers for the diagnosis and staging of ALD. Methods A total of 127 patients with early liver injury, 40 patients with alcoholic cirrhosis (ALC) and 40 healthy controls were included in this study. Patients with early liver injury included 45 patients with alcoholic liver disease (ALD), 40 patients with non-alcoholic fatty liver disease (NAFLD) and 40 patients with viral liver disease (VLD). The differential metabolites in serum samples were analyzed using ultra-high-performance liquid chromatography-quadrupole/time-of-flight mass spectrometry, and partial metabolites in the differential metabolic pathway were identified by liquid chromatography– tandem mass spectrometry. Results A total of 40 differential metabolites and five differential metabolic pathways in the four groups of patients with early liver disease and healthy controls were found, and the metabolic pathway of primary bile acid (BA) biosynthesis was the pathway that included the most differential metabolites. Therefore, 22 BA profiles were detected. The results revealed that the changes of BA profiles were most pronounced in patients with ALD compared with patients with NAFLD and VLD, in whom 12 differential BAs were diagnostic markers of ALD (AUC = 0.883). The 19 differential BAs in ALC and ALD were diagnostic markers of the stage of alcoholic hepatic fibrosis (AUC = 0.868). Conclusion BA profiles are potential indicators in the diagnosis of ALD and evaluation of different stages.

Modern Possibilities of Liver Diffusion-Weighted Magnetic Resonance Images in the Diagnosis of Alcoholic Liver Disease

Objective: to evaluate the current possibilities of diffusion-weighted imaging (DWI) in liver magnetic resonance imaging (MRI) for the diagnosis of alcoholic liver disease (ALD).Material and methods. The examined patients were at the inpatient and outpatient stages of observation in the gastroenterology department on the basis of the Clinical Hospital No. 1 (Smolensk) and received treatment for diffuse liver diseases of alcoholic etiology. The study included 128 patients: 76 (59%) males and 52 (41%) females, mean age 42.3 ± 4.7 years. Patients were monitored from 2019 to 2022. All of them underwent abdominal organs ultrasound with liver clinical elastography and liver MRI with DWI; in 34 cases liver multi-slice computed tomography was performed.Results. When comparing the results of a qualitative assessment of liver DWI MRI with the CAGE (Cut, Annoyed, Guilty, Eye-opener) test data and the results of patients and relatives survey about the use of alcoholic beverages, a high correlation was established between the diffusion restriction in the liver during MRI and impaired withdrawal regimen (r = 0.901). The diagnostic and prognostic significance of the developed criteria for liver DWI MRI in patients with ALD at admission was assessed: for qualitative assessment AUROC 0.827 (95% CI 0.792–0.873), for quantitative assessment AUROC 0.949 (95% CI 0.912–0.981); in dynamic observation: for qualitative assessment AUROC 0.958 (95% CI 0.925–0.984), for quantitative assessment AUROC 0.947 (95% CI 0.947–0.981).Conclusion. The obtained quantitative indicators of liver DWI MRI make it possible to predict the clinical form of ALD: apparent diffusion coefficient for steatosis is 2.66 ± 0.9 × 10–3 mm2/s, for steatohepatitis – 2.14 ± 0.5 × 10–3 mm2/s, for hepatitis – 1.75 ± 0.6 × 10–3 mm2/s, for cirrhosis – 1.15 ± 0.6 × 10–3 mm2/s (AUROC 0.948; 95% CI 0.922–0.983). Qualitative parameters of liver DWI MRI (there is/is not a diffusion restriction) predict violations of the withdrawal regimen in patients with ALD in all its clinical forms (AUROC 0.931; 95% CI 0.822–0.979).

S1329 Nonalcoholic Fatty Liver Disease in Overweight Primary Care Patients: Comparison of Clinical Diagnosis vs Fibrosis-4 and Hepatic Steatosis Index Scores

Introduction: More than two-thirds of US adults are overweight or have obesity, a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD is asymptomatic until late in the disease. Therefore, the aim of this study was to assess whether early evidence of NAFLD is being appropriately diagnosed in a primary care patient population. Methods: A retrospective data analysis was performed of overweight (BMI ≥ 23 for Asians or ≥ 25 for other races) patients (age ≥ 18) who had established primary care (defined as ≥ 2 visits in primary care) in a large healthcare system in Minneapolis between 2010 to 2019. Patients with a diagnosis of alcoholic liver disease, and hepatitis B and C virus infections were excluded. The clinical diagnosis of NAFLD was based on ICD-9 and -10 codes (571.8, K75.81, K76.0). Fibrosis 4 (FIB-4) score ≥ 3.25 and hepatic steatosis index (HSI) score ≥ 36 were calculated as markers of hepatic fibrosis and fatty liver disease, respectively. ICD codes were compared to FIB-4 and HSI scores. Results: 373,917 patients met study criteria; 52% were female, 86% white, average BMI at first primary care visit was 31.1 (SD 6.0) and average age was 46.4 (SD 17.3). At the end of the follow-up period in 2019, 6.6% of patients met criteria for hepatic fibrosis by FIB-4 score and 90.4% met criteria for fatty liver disease by HSI score. Among patients who met criteria for hepatic fibrosis by FIB-4 score, only 10.7% had been diagnosed as having NAFLD/NASH by ICD code; among those who met criteria for fatty liver disease by HSI criteria, only 6% had been diagnosed by ICD code (Table). A formal diagnosis of NAFLD/fatty liver/NASH by ICD code had been made in 4.1% of patients. Out of these patients, 97.7% had fatty liver by HSI score and 11.9% had hepatic fibrosis by FIB-4 score. Limitations: For 110,994 patients, a FIB-4 or HSI score could not be calculated. Duration of follow up was maximally nine years. Treatment information was not analyzed. Conclusion: Hepatic fibrosis and fatty liver disease are underdiagnosed in this healthcare system based on abnormal FIB-4 and HSI scores. These results are likely generalizable to other healthcare systems in the US. Given the frequency and reversibility of early NAFLD, primary care providers should have a low threshold to screen using simple labs tests (AST, ALT, platelet count) for fatty liver disease and hepatic fibrosis. Those with abnormal results should pursue intensive lifestyle modification and weight loss treatment. Table 1. - *Data Missing: Data to calculate FIB-4 or HSI score not available Yes Percentage No Data Missing Total (N) FIB-4 score ≥ 3.25 15,696 6.6 221,093 137,128 373,917 Patients with abnormal FIB-4 score who are diagnosed by ICD code 1,686 10.7 14,010 0 15,696 HSI score ≥ 36 241,357 90.4 25,543 107,017 373,917 Patients with abnormal HSI score who are diagnosed by ICD code 14,470 6.0 226,887 0 241,357 NAFLD/Fatty Liver/NASH diagnosis by ICD code 15,324 4.1 358,593 0 373,917 FIB-4 score ≥ 3.25 among patients who are diagnosed with NAFLD/fatty liver/NASH by ICD code 1,686 11.9 12,468 1,170 15,324 HSI score ≥ 36 among patients who are diagnosed with NAFLD/fatty liver/NASH by ICD code 14,470 97.7 346 508 15,324

A Clinical Study of Spectrum of Liver Diseases in Alcoholic with Respect to Predictors of Severity and Prognosis

Objectives: Alcoholic liver disease (ALD) is the second most common cause of mortality in humans every year occurring due to overconsumption of alcohol. The spectrum of ALD includes fatty liver/steatosis, alcoholic hepatitis, steatohepatitis, chronic hepatitis with liver fibrosis or cirrhosis, and hepatocellular carcinoma. The diagnosis of ALD can generally be made based on clinical and laboratory features alone in patients with a history of significant alcohol consumption. Prognostic scores such as Child-Pugh classification, MELD, MELD-Na, and Maddrey’s discriminant function (MDF) are used commonly to predict mortality in patients with ALD.The aim of the study is to evaluate the spectrum of liver diseases in alcoholic patients and factors predicting severity and prognosis in such patients. Material and Methods: This was a prospective, longitudinal and observational study conducted on 83 patients with ALD admitted in medicine inpatient department from January 2019 to December 2020. Demographic data, biochemical parameters, and clinical features of the patients were evaluated. From the data obtained prognostic scores of Child-Pugh classification, MELD, MELD-Na, and MDF were calculated. Patients were clinically evaluated and all the biochemical parameters and scores were assessed on admission and after the 7th and 30th days. Results: The majority of the patients were males (95.18%) with a mean age of 49.44 ± 7.67. The mean duration of hospital stay of the patients was 34.33 ± 12.98 and approximately 76% of the patients were still consuming alcohol at the time of hospitalisation. Jaundice and ascites were present in all 83 patients, and loss of appetite (85.5%) and nausea and vomiting (78.3%) were the most common clinical features. Complications such as hepatic encephalopathy (85.5%) and oesophageal varices (80.72%) were common on admission. MELD and MELD-Na score &gt; 24 was found in 59 patients and discriminant function (DF) score was more than 32 in 81 patients. Mortality analysis showed that 6 (7.2%) patients died within 1 week of admission and MELD was found to be the best predictor of mortality compared to CTP, MELD-Na, and DF by 7 days. Thirty-two (38.5%) patients died within 30 days of admission. MELD-Na was found to be the best predictor of mortality compared to CTP, MELD, and DF by 30 days. Conclusion: The presence of ascites, hepatic encephalopathy, high bilirubin, low albumin, high creatinine, high INR, and low sodium is found to be independent predictors of mortality. MELD and MELD-Na are good predictors of mortality over the short-term (7–30 days).

Modern possibilities of quantitative assessment of diffusion-weighted images in magnetic resonance imaging of liver in diagnosis of alcoholic liver disease

Objective. To evaluate the modern possibilities of quantitative assessment of diffusion-weighted imaging (DWI) using magnetic resonance imaging of the liver (MRI) in alcoholic liver disease (ALD). Material and methods. 121 patients with ALD were examined. The structure of clinical forms: 27 (22.3 %) – steatosis, 29 (23.9 %) – steatohepatitis, 48 (39.7 %) – hepatitis, 17 (14.1 %) – cirrhosis. The patients were hospitalized in the gastroenterology department of the Clinical Hospital No. 1 in Smolensk (September 2019 – March 2020), followed by outpatient observation (April 2020 – January 2022). All patients underwent a comprehensive radiological examination, including ultrasound examination (ultrasound) of the abdominal organs with clinical elastography (CE) of the liver (n = 121) (transient elastography/compression elastography/shear wave elastography), MRI with DWI of the liver was mandatory in the design of the study (n = 121). Results. According to the CE data, there is no possibility to confirm the clinical form of ALD in a patient, the stage of the fibrous process in the liver parenchyma is limited by marginal results; a liver biopsy allows you to fully establish the stage of fibrosis and suspect the clinical form of ALD. According to the quantitative assessment of DWI of the liver during MRI in patients with ALD, criteria for clinical forms were established in comparison with CE: for steatosis – 2.66 ± 0.90 × 10 –3 mm 2 /sec corresponds to F0–F1, for steatohepatitis – 2.14 ± 0,50 × 10 –3 mm 2 /sec – F1–F2, for hepatitis – 1.75 ± 0.60 × 10 –3 mm 2 /sec – F2–F3, for cirrhosis – 1.15 ± 0.60 × 10 –3 mm 2 /sec – F4 (AUROC = 0.985; 95 % CI: 0.945–0.912). Conclusion. Upon admission and monitoring of patients (after 1, 3, 6, 9, 12 months), there is a high correlation in assessing the comparison of quantitative indicators of DWI with CE (r = 0.873) and an average correlation with liver biopsy data (r = 0.715). The diagnostic and prognostic significance of the developed criteria for DWI of the liver during MRI in patients with ALD at admission was assessed for quantitative assessment of AUROC = 0.908 (95 % CI: 0.875–0.911).

PET Imaging of Bromodomain and Extra-Terminal Domain Inhibitors for the Noninvasive Assessment of Metabolic Changes in the Liver and Brain of Early-Stage Alcoholic Liver Disease.

Alcoholic liver disease (ALD) has a significant impact on human health and is one of the leading causes of liver disease mortality. The early and exact diagnosis of ALD is very important since the early stage of disease progression can be reversible. Although ALD can be evaluated by ultrasound, CT, or MRI, there is still no imaging technique sufficient in the diagnosis of early-stage ALD. Of the current studies, epigenetic modulation plays a significant role in the development and progression of ALD. In this work, we evaluate whether BRDs play a vital role in the early-stage ALD using our new PET imaging probe of BET proteins, [11C]CW22. PET/CT imaging of [11C]CW22 and [18F]FDG was used to identify early-stage lesions of livers and brains in the mice model. We found that the average uptake values of livers and brains in early-stage ALD were significantly increased for [11C]CW22 PET/CT imaging but only slightly changed in [18F]FDG PET/CT imaging. Consistently, we also found that BRD 3, 4 protein expression levels were significantly higher in the liver and brain tissues of early-stage ALD. Furthermore, through Pmod software, we found that [11C]CW22 PET/CT uptakes in the brain stem, cerebellum, and midbrain were significantly up-regulated in the early-stage ALD. In conclusion, BRDs were important mediators of damage in early-stage ALD. [11C]CW22 PET/CT imaging can detect the early-phase alcohol-induced damage of livers and brains, which will likely lead to human trials in the future.

Leukocyte cell-derived chemotaxin-2 and fibroblast growth factor 21 in alcohol-induced liver cirrhosis.

BACKGROUNDThe importance of early diagnosis of alcoholic liver disease underscores the need to seek better and especially non-invasive diagnostic procedures. Leukocyte cell-derived chemotaxin-2 (LECT2) has been widely studied to determine its usefulness in monitoring the course of non-alcoholic fatty liver disease but not for alcoholic liver cirrhosis (ALC).AIMTo determine the concentration of LECT2 in the blood serum of patients in relation to progressive stages of ALC, its relation to fibroblast growth factor 1 (FGF-1) and FGF-21, and to examine the possible wider use of LECT2 in diagnosing ALC.METHODSA retrospective case-control study was conducted with 69 ALC cases and 17 controls with no ALC. Subjects were recruited from the region of Lublin (eastern Poland). Liver cirrhosis was diagnosed based on clinical features, history of heavy alcohol consumption, laboratory tests, and abdominal ultrasonography. The degree of ALC was evaluated according to Pugh-Child criteria (the Pugh-Child score). Blood was drawn and, after centrifugation, serum was collected for analysis. LECT2, FGF-1, and FGF-21 were determined using enzyme-linked immunosorbent assay kits.RESULTSThe LECT2 Levels in the control group were 18.99 ± 5.36 ng/mL. In the study groups, they declined with the progression of cirrhosis to 11.06 ± 6.47 ng/mL in one group and to 8.06 ± 5.74 ng/mL in the other (P < 0.0001). Multiple comparison tests confirmed the statistically significant differences in LECT2 Levels between the control group and both test groups (P = 0.006 and P < 0.0001). FGF-21 Levels were 44.27 ± 64.19 pg/mL in the first test group, 45.4 ± 51.69 pg/mL in the second (P = 0.008), and 13.52 ± 7.51 pg/mL in the control group. The difference between the control group and the second test group was statistically significant (P = 0.007).CONCLUSIONWe suggest that LECT2 may be a non-invasive diagnostic factor for alcohol-induced liver cirrhosis. The usefulness of LECT2 for non-invasive monitoring of alcohol-induced liver cirrhosis was indirectly confirmed by the multiple regression model developed on the basis of our statistical analysis.

Patterns and Severity of Alcohol Consumption in Patients with Alcoholic Liver Disease: A Cross-Sectional Study

Introduction: Alcohol is a known cause of liver cirrhosis, with its incidence increasing in relation to the total amount and duration of intake. Excessive consumption of alcohol remains the main cause of alcohol-related liver disease and associated complications and deaths. Aims: To delineate the drinking patterns and severity of alcohol consumption in alcoholic liver disease patients. Methods: A descriptive cross sectional study was conducted among 95 patients of both sexes with the diagnosis of alcoholic liver disease (ALD), who were admitted in Medicine ward at Nepalgunj Medical College, Nepalgunj. The diagnosis of ALD was confirmed by the criteria of the ICD-10-CM. The severity of alcohol drinking screened and categorized as “low-risk drinkers,” “hazardous drinkers,” and “harmful drinkers” were based on the AUDIT score. Results: Among a total of 95 ALD patients, the mean age was 45.10 ±7.60 years, the mean duration of alcohol use was 22.6 ±7.65 years and the average amount of alcohol consumed in grams/day was 240 ± 35. Majority of the patients consumed locally brewed alcohol, Raksi 46.3% followed by Jaad 22.1% and Others 11.6%. Very few patients consumed commercially available Spirits 6.3% or Beer 13.7%. Majority of patients were found to be drinking regular with intermittent bingeing pattern 61%, outside meal times 69.5% and hazardous drinking 53.7%. Conclusion: Overall our analyses indicated a precise picture of drinking patterns in ALD patients that are profoundly influenced on several cofactors like alcohol type, duration of exposure, drinking patterns, cultural habits, availability of homemade beverages and individual susceptibility. We recommend screening for alcohol abuse in all adult patients presenting to the hospital as early detection of ALD can decrease its both morbidity and mortality.

Modern approaches to the diagnosis of alcoholic liver disease

The article presents up-to-date information about diagnostic methods for one of the most common and socially significant hepatological diseases-alcoholic liver disease. The most frequent clinical manifestations of this pathology are asthenic, dyspeptic, right hypochondrium, cholestatic, neurological, edematous-ascitic and hemorrhagic syndromes. Validated questionnaires are intended for standardized alcohol use screening, the gold standard among which is the AUDIT questionnaire aimed at identifying alcohol use disorders. Most of the physical signs of chronic alcohol abuse are presented in the modified LeGo grid. Direct indicators (markers) of laboratory diagnosis of alcohol use include the determination of phosphatidyl ethanol and ethyl glucuronide in blood serum and urine; ethyl glucuronide and fatty acid ethyl esters in hair; ethanol, aminotransferase, peroxidase, ethylglucuronide, ethyl sulfate, haptoglobin, etc., in saliva. Indirect markers include macrocytic anemia, neutrophilic leukocytosis, increased activity of gamma-glutamyl transpeptidase, transaminases, de Ritis coefficient, bilirubin, alkaline phosphatase, serum immunoglobulin A and gamma globulins. Determination of carbohydrate-deficient transferrin is recommended as a preferred marker of alcohol intoxication. In order to determine the degree of fibrosis, predictive diagnostic serum tests are used, both non-proprietary (APRI, Forns) and commercial (Fibrometer, Hepascore, Fibrospect etc.). The methods of visual diagnostics of liver diseases include ultrasound, magnetic resonance and computed tomography, which can determine steatosis, exclude other causes of liver damage, reveal signs of severe fibrosis or cirrhosis, as well as their complications, but none of them allows to establish the etiology of the lesion. A promising direction is to determine the degree of steatosis when measuring the controlled parameter of ultrasound attenuation, implemented in the Fibroscan apparatus. The most accurate methods for diagnosing steatosis today are magnetic resonance imaging of the liver in the mode of determining the proportion of fat, weighted by proton density, and proton magnetic resonance spectroscopy. To determine the degree of fibrosis, a transient, two-dimensional shear wave and magnetic resonance elastography are used. Biopsy followed by morphological examination is the gold standard for the diagnosis of alcoholic liver disease, which confirms the presence of liver damage, establishes its stage and often allows confirming alcoholic genesis. However, this procedure has a number of significant drawbacks, so it is advisable to use non-invasive diagnostic techniques for screening, primary examination and further monitoring of the patients condition in dynamics.

Usefulness of gamma-glutamyl transpeptidase and mean corpuscular volume in alcoholic liver disease

Introduction: Excessive consumption of alcohol and alcoholism are widely observed risk factors for damage to health and social problems. Early identification of alcoholic liver disease could improve the possibility of early treatment and reduce damage to health and health costs. Our present study was anticipated to establish the association between the liver enzyme gamma-glutamyl transpeptidase and an haematocrit parameter mean corpuscular volume in alcohol liver disease patients. Materials and Methods: Our study includes 100 subjects, with 50 cases and 50 controls. Serum was collected for the analyses of GGT, liver enzymes ALP, AST, ALT, total protein, albumin, bilirubin. Haemoglobin, Mean corpuscular volume, PCV and RBC were also analyzed. The statistical relationship between AST and ALT has been calculated. Statistical data analysis was performed by SPSS 20 software. Results: The values of the GGT and MCV levels were significantly increased in patients compared to controls (p Conclusion: The Overall verdict of this study shows that the increase in ?GT and MCV levels in ALD patients can be used for added diagnostic markers for the diagnosis of alcoholic liver disease. Keywords: Gamma glutamyl transpeptidase (GGT), Mean corpuscular volume (MCV), Alcoholic liver disease (ALD).

Combined herbal medicine for chronic alcoholic liver disease

Alcohol abuse with resultant alcoholic liver disease (ALD) are a leading cause of morbidity and mortality worldwide. Due to absence of clinical symptoms of the disease in the early stages, it is diagnosed in the later stages with higher complications and mortality rates. Diagnosis of ALD requires a better determination of life history and prognostic factors, as well as the search for reliable non-invasive techniques. Early detection of alcoholic steatohepatitis in primary care settings and subsequent interventions will facilitate the satisfaction of this requirement. Despite some important advances in understanding the pathogenesis and clinical features of ALD, the past 40 years have not seen significant advances in the therapy. The long-term alcohol abstinence is the main therapy for ALB patients, regardless of the disease stage. It is associated with improved clinical outcomes across the ALD spectrum: from asymptomatic early cases to complicated severe cases. Clinical ultimate outcomes depend on the ALD stage. The ultimate outcomes are associated with normalisation of abnormal laboratory test results and reduction in liver fibrosis in compensated patients. These ultimate outcomes can be monitored using non-invasive tools, but current medical interventions are largely limited and ineffective. Supportive therapy forms the basis of the treatment, it is worth paying special attention to combined herbal medicines as less toxic ones with single contraindications and consistent with the desire of many patients to use natural preparations.

The Association Between Alcoholic Liver Disease and Alcohol Tax.

The incidence of alcoholic liver disease (ALD) has increased, causing it to become a primary indication for liver transplantation in the United States. We hypothesized an association between alcohol taxation and prevalence of ALD. We conducted a retrospective study of united network for organ sharing (UNOS) waitlist additions for liver transplantation between January 2007 and December 2016. We also analyzed the average excise tax (2007-2016) for beer, wine, and spirits in listing states of liver transplant waitlist additions (LTWA). There were 104 805 adult UNOS LTWA with assigned diagnoses, an annual increase from 22% to 28%. There were 24 316 LTWA with ALD diagnosis. The mean value for beer tax was significantly lower for ALD patients than for non-ALD patients across all age groups (P < .001). The analysis demonstrated significantly more ALD in waitlisted patients 35-54 years of age (30%), compared with 18-34 years (10%) and ≥55 years (20%), P < .001. The data confirmed significantly more ALD Medicaid patients in the 35-54 year age group (28%) compared with other age groups, P < .001. Our research demonstrated an association between lower beer tax and higher ALD prevalence across all age groups. We found a larger percentage of middle-aged (35-54 years) Medicaid patients listed with ALD. These findings raise the need for further investigation of a potential public health concern for an association between ALD and beer tax, especially for middle-aged patients of lower socioeconomic status.

Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis.

This meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery. Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible. Of the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14-35%, I2=0%]. In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9-21%, I2=41.1%). Postoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.

Morphological peculiarities of the liver in alcoholic hepatitis in combination with arterial hypertension

The purpose of the study is to investigate the morphological features of the liver with alcoholic hepatitis in combination with arterial hypertension. Material and methods. Autopsy material (34 cases) of the liver of the deceased with the clinical diagnosis of alcoholic liver disease was investigated. The definitive diagnosis of the form of alcoholic liver damage was revealed by microscopic examination of histological sections of the liver using the method of inspection staining (hematoxylin and eosin) and three histochemical methods: staining with chromotropic-aqueous blue by N. Z. Slinchenko, bromphenol blue according to Mikel Calvo (to evaluate the processes of oxidative modification of proteins and to estimate the total protein concentration), staining free amino groups of proteins in ninghydrin-Schiff and reaction Yasuma Ichikawa and evaluation processes for limited proteolysis. Results. Histological examination of liver preparations of patients with alcoholic hepatitis showed a typical picture of the inflammatory process in combination with steatosis. The inflammation was localized mainly in the connective tissue of the portal tracts in the form of lymphocytic infiltrates with impurities of polymorphonuclear leukocytes. The proportion of infiltrates in patients with hypertension did not differ, on average, from patients without hypertension. The density of infiltration by lymphocytes and polymorphonuclear leukocytes was very uneven, even within one liver. But it can be noted that the infiltration of the portal tracts was generally more dense than the periportal areas of the liver lobules. The portal tract stroma in some patients was slightly swollen. The sinusoids of the liver lobules are somewhat enlarged, with plethora. There are hemorrhages in the stroma of the portal tracts and around them. In hypertension, the specific volume of hemorrhage is more than twice the rate of patients with alcoholic hepatitis without arterial hypertension. In arterial hypertension, the percentage of hepatocytes in the state of fatty dystrophy and in the state of necrosis is much higher. Fatty dystrophy was predominantly a large droplet in both groups of the study, some of the hepatocytes were with signs of medium-sized fatty dystrophy. The nature of the fat droplets did not depend on the presence of hypertension. Necrosis was either colliquative (more common), or in other cases, necrosis was fat. In arterial hypertension, the specific connective tissue volume of portal tracts and collagen fibers was higher (p <0.05). For hepatocytes with signs of fatty dystrophy, the R/B coefficient in hypertension exceeded this in observations of alcoholic hepatitis without hypertension. Alcoholic hepatitis on the background of hypertension in all hepatocytes there is also an increase in processes of limited proteolysis. An important fact was the establishment of a higher level of proteolysis in connective tissue fibers. Conclusions. In alcoholic hepatitis in patients with hypertension compared with patients without hypertension, there is an increase in the percentage of hepatocytes in the state of fatty dystrophy and the percentage of hepatocytes in a state of necrosis, increase in the specific volume of hemorrhage, increase in the specific volume of tissue. collagen fibers and the optical color density of collagen fibers. There is also an intensification of the processes of free radical oxidation of proteins and limited proteolysis in hepatocytes and connective tissue fibers.

Paraumbilical vein aneurysm: case report

A 48-year-old female patient was found to have a paraumbilical vein saccular aneurysm, which is a rare consequence of portal hypertension. She presented with right upper quadrant pain and had a known diagnosis of alcoholic liver disease. This had progressed since her last admission. We discuss the multimodality images obtained, diagnosis and complications associated with this pathology.