Early Detection Of Alcoholic Liver Disease Research Articles

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.

SAT-446 - Making sense of liver function tests: Is the Intelligent Liver Function Test (iLFT) cost-effective?

Background and Aims: Liver function tests are widely used by GPs in primary care to identify liver disease. Abnormal results are common though, and are followed by (i) a lengthy process of retesting and referral which is costly to both patients and health services, or (ii) are left uninvestigated – potentially overlooking curable liver disease which would otherwise be fatal. iLFT is a semi-automated liver test cascading system with a structured diagnostic algorithm to maximise the efficiency of requesting LFTs and improve diagnosis. This study undertook a cost-effectiveness analysis of the iLFT decision tool compared to routine practice in Scotland, UK. Method: An economic evaluation alongside the trial, and lifetime model undertaken from the perspective of NHS of Scotland. A step wedge design trial was carried out which compared effectiveness of diagnosis before and after the introduction of the iLFT system. Within trial outcomes are reported as incremental cost per correct diagnosis at six months follow up, while a Markov model was used to extrapolate out to a lifetime analysis with discounted costs and quality adjusted life years gained in each arm, to account for early detection of Alcoholic Liver Disease (ALD) and Non-alcoholic Liver Fatty liver Disease (NAFLD). Probabilistic sensitivity analysis was undertaken with a 1000 iteration monte carlo simulation. Results: The within trial analysis found costs to be £185 (CI 95% £166, £202) and £328 (CI 95% £231, £425) in routine practice and iLFT arms respectively. Probability of correct diagnosis (true positive and true negative)was 0.41 (CI 95% 0.37, 0.45) in routine and 0.92 (95% CI 0.85, 0.99) in iLFT, resulting in an ICER of £284 (CI 95% £128, £440). The lifetime model found iLFT to dominate routine practice with an incremental cost saving of £3216 (CI 95% -£7643, -£897) and an incremental QALY gain of 0.021 (CI 95% 0.009, 0.04). Conclusion: iLFT increases Liver diagnosis, while improves quality of care and is cost effective with a lowICER of £284 per correct diagnosis and over a patient lifetime is a dominant strategy saving the NHS an average £3,216 per patient. Given these results iLFT should be recommended and widely implemented across the NHS.

Enhanced expression of c-myc in hepatocytes promotes initiation and progression of alcoholic liver disease

Background & Aims Progression of alcoholic liver disease (ALD) can be influenced by genetic factors, which potentially include specific oncogenes and tumor suppressors. In the present study, we tested the hypothesis that aberrant expression of the proto-oncogene c-myc might exert a crucial role in the development of ALD. Methods Expression of c-myc was measured in biopsies of patients with ALD by quantitative real-time PCR and immunohistochemistry. Mice with transgenic expression of c-myc in hepatocytes (alb-myc tg ) and wild-type (WT) controls were fed either control or ethanol (EtOH) containing Lieber-DeCarli diet for 4weeks to induce ALD. Results Hepatic c-myc was strongly upregulated in human patients with advanced ALD and in EtOH-fed WT mice. Transcriptome analysis indicated deregulation of pathways involved in ER-stress, p53 signaling, hepatic fibrosis, cell cycle regulation, ribosomal synthesis and glucose homeostasis in EtOH-fed alb-myc tg mice. Transgenic expression of c-myc in hepatocytes with simultaneous EtOH-uptake led to early ballooning degeneration, increased liver collagen deposition and hepatic lipotoxicity, together with excessive CYP2E1-derived reactive oxygen species (ROS) production. Moreover, EtOH-fed alb-myc tg mice exhibited substantial changes in mitochondrial morphology associated with energy dysfunction. Pathway analysis revealed that elevated c-myc expression and ethanol uptake synergistically lead to strong AKT activation, Mdm2 phosphorylation and as a consequence to inhibition of p53. Conclusions Expression of c-myc and EtOH-uptake synergistically accelerate the progression of ALD most likely due to loss of p53-dependent protection. Thus, c-myc is a new potential marker for the early detection of ALD and identification of risk patients.