Alcohol abuse may resume after critical surgery

Life-saving surgery to prevent repeated severe bleeding from ruptured veins in the esophagus or upper stomach may not induce some patients with alcoholic liver disease to stop drinking alcohol, researchers report.

Such a surgical procedure may be necessary to reduce the pressure in the veins of the esophagus and upper stomach among patients with cirrhosis, a scarring of the liver frequently caused by alcohol abuse.

The study group consisted of 132 patients with cirrhosis, including 78 with alcoholic liver disease, lead author Dr. Michael R. Lucey, of the University of Wisconsin School of Medicine and Public Health, and colleagues report.

The investigators used patient and family member interviews to determine drinking patterns among 132 cirrhosis patients with who had surgically implanted shunts to reduce the pressure in their esophageal and upper stomach veins.

Twenty to 40 percent of patients with alcoholic liver disease acknowledged alcohol use during 5 years after receiving the pump. About one third of those with alcoholic liver disease reported drinking more than four alcoholic drinks per day during follow-up, the researchers report in the American Journal of Gastroenterology.

The patients with alcoholic liver disease were twice as likely to drink alcohol during follow-up as patients with cirrhosis from other causes.

Continued alcohol use among patient with alcoholic liver disease was associated with a 153 percent increase in gamma-glutamyl transpeptidase (GGT), a liver enzyme indicative of liver disease. These patients also had a significantly increased risk repeat hemorrhage and death.

Lucey and colleagues conclude that a "substantial minority" of patients will return to drinking alcohol after experiencing a life-threatening complication. They recommend that patients with alcoholic liver disease should be encouraged to abstain from alcohol.

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Blood test can track alcohol consumption

A simple blood test that identifies the odds of heavy drinking in the previous four to six weeks is being used in several settings as an objective, non-judgmental way of identify problem drinkers and intervene, a researcher told the annual meeting of the American Association for Clinical Chemistry (AACC) this week.

"The test for heavy drinking works by measuring the changes in blood chemistries due to the effect of heavy drinking on various organ systems in the body," AACC presenter Dr. James Harasymiw, Director of Alcohol Detection Services in Big Bend, Wisconsin noted in a telephone interview with Reuters Health.

It's estimated that about 100,000 Americans die each year from alcohol abuse, including more than 17,000 people who die annually in alcohol-related traffic accidents.

"We defined heavy drinking as a woman having more than three drinks a day or a man having more than four drinks a day or binge drinking at least two times a week," Harasymiw said. "The National Institute on Alcohol Abuse and Alcoholism has data showing that medical problems and psychological and social problems start to occur at this level of drinking."

The test is currently being used in several different settings, Harasymiw said. "It is being used in alcoholism treatment centers and we have a pilot project in one county in Wisconsin with repeat offense drunk drivers to see if we can see if we can reduce the rate of recidivism," he explained.

Drug courts are using the test to monitor individuals and the family courts in Wisconsin are using it where there are concerns about child safety, he told Reuters Health.

"We've used the test for heavy drinking to allow people to rebuild credibility after they've gone through treatment and are able to demonstrate that they are staying sober and that's allowed some women to get their children back," Harasymiw said.

Los Angeles County uses the test in some of their pre-employment screening.

The next proving ground for the test is doctor's offices. "We are hoping in time to have doctors use it; doctors have been resistant to screening for heavy drinking but we are trying to get a pilot going in medical settings to see if it can be integrated into office practice," Harasymiw said.

Doctors could show patients test results to help convince them that their drinking is causing "serious damage" to their body, he added.

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