Drinking for fun? Beware of alcoholic liver disease

Author: Shen Lijun, deputy chief physician of the Fifth Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

In today's society, with the accelerated pace of life and the increase in work pressure, more and more people tend to regard drinking as a spiritual haven to relax and relieve tense nerves. At the same time, drinking has become an indispensable medium of communication in various social activities. However, it is worth noting that although drinking can bring psychological relaxation and social convenience to a certain extent, long-term excessive drinking can cause serious damage to physical health. Among them, alcoholic liver disease, as a liver disease caused by long-term and heavy drinking, is particularly harmful. This disease usually manifests as fatty liver in the early stage, and can then develop into alcoholic hepatitis, liver fibrosis and cirrhosis; severe alcoholism can induce extensive liver cell necrosis and even liver failure, threatening the patient's life safety.

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1. What are the risk factors for alcoholic liver disease?

There are many factors that affect the progression or aggravation of alcoholic liver damage. At present, domestic and foreign studies have found that the risk factors mainly include alcohol consumption, years of drinking, types of alcoholic beverages, drinking methods, gender, race, obesity, hepatitis virus infection, genetic factors and nutritional status.

1. According to epidemiological survey data, liver damage caused by ethanol (alcohol) has a threshold effect, that is, when the amount of drinking or the number of years of drinking reaches a certain level, the risk of liver damage will increase greatly.

2. There are many types of alcoholic beverages, and different alcoholic beverages cause different damage to the liver. The way of drinking is also a risk factor for alcoholic liver damage. Drinking on an empty stomach is more likely to cause liver damage than drinking with a meal.

3. Women are more sensitive to alcohol-mediated liver toxicity. Compared with men, smaller doses and shorter drinking periods may lead to more severe alcoholic liver disease. There is a significant difference in blood alcohol levels between men and women when drinking the same amount of alcoholic beverages. Not all drinkers will develop alcoholic liver disease, it only occurs in a part of the population, indicating that there are individual differences between groups in the same region.

4. The increase in mortality from alcoholic liver disease is related to the degree of malnutrition. Vitamin A deficiency or decreased vitamin E levels may also aggravate liver damage. A diet rich in polyunsaturated fatty acids can promote the progression of alcoholic liver disease, while saturated fatty acids can protect against alcoholic liver disease. Obesity or overweight can increase the risk of progression of alcoholic liver disease.

5. Hepatitis virus infection and alcohol have a synergistic effect on liver damage. Drinking alcohol on the basis of hepatitis virus infection, or concurrent hepatitis B virus or hepatitis C virus infection on the basis of alcoholic liver disease, can accelerate the occurrence and development of liver disease.

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2. What are the clinical diagnostic criteria for alcoholic liver disease?

The diagnosis of alcoholic liver disease first requires understanding the patient's drinking volume and drinking history, which must at least meet the following conditions: a history of long-term drinking, generally more than 5 years, with an ethanol (alcohol) volume of ≥40 g per day for men and ≥20 g per day for women, or a history of heavy drinking within 2 weeks, with an ethanol volume of >80 g per day; secondly, attention should also be paid to the influence of factors such as gender and genetic susceptibility.

Alcohol conversion formula: g = alcohol consumption (ml) × alcohol content (%) × 0.8. Simply put, if a man drinks for more than 5 years and drinks 100ml of 50-proof liquor every day on average, he can meet the above standards.

The clinical manifestations of alcoholic liver disease are not specific. It may be asymptomatic or may be accompanied by symptoms of other types of liver disease, such as right upper abdominal distension and pain, lack of appetite, fatigue, weight loss, jaundice, etc. As the disease worsens, symptoms such as liver palms, spider nevi and neuropsychiatric symptoms may appear.

The diagnosis of alcoholic liver disease is an exclusive diagnosis, which means that it is necessary to exclude hepatotropic virus infection, as well as other factors such as drugs, toxic liver damage and autoimmune liver disease. The diagnosis can only be made based on the amount of alcohol consumed, clinical manifestations, laboratory test results and imaging characteristics.

3. What are the treatment principles for alcoholic liver disease?

The treatment principles for alcoholic liver disease are: quitting drinking and nutritional support, reducing the severity of alcoholic liver disease, improving existing secondary malnutrition and symptomatic treatment of alcoholic cirrhosis and its complications. Among them, quitting drinking is the most important treatment measure, and no drug treatment can replace this.

Liver transplantation may be considered for patients with severe alcoholic cirrhosis, but patients are required to abstain from alcohol (3 to 6 months) before liver transplantation and have no severe alcohol damage to other organs.

4. After treatment and the condition stabilizes, can I continue to drink alcohol?

Patients with alcoholic liver disease often ask doctors: "I have stopped drinking for several months, and now my liver function has returned to normal. Can I continue drinking?" The answer is no. This idea is wrong. Because the liver structure of patients with alcoholic liver disease, especially alcoholic cirrhosis, has undergone some irreversible changes to a certain extent, similar to a squeezed honeycomb. In this case, it is not easy to restore it to its original state, and of course, it cannot be stressed anymore.

Some patients may ask: "Can I drink less? Or drink some red wine or beer?" In fact, patients don't need to ask the doctor, they will have the answer in their hearts, but this is of course not okay. As mentioned earlier, the occurrence of alcoholic liver disease varies from person to person, and not all drinkers will develop alcoholic liver disease. However, patients with alcoholic liver disease or alcoholic cirrhosis are necessarily sensitive to alcohol, so these patients must not continue to drink.

5. What is alcohol withdrawal syndrome? What are its clinical manifestations and treatment measures?

1. Alcohol withdrawal syndrome refers to various syndromes with mental disorders or autonomic dysfunction as the main manifestations that occur in alcohol-dependent patients who drink a lot for a long time when they suddenly stop drinking or reduce their alcohol intake. Drinking again can quickly relieve the symptoms. Such patients have a history of repeated drinking for many years, and the disease occurs 6 to 24 hours after they are forced to stop drinking due to certain diseases or accidents.

2. The clinical manifestations of alcohol withdrawal syndrome include anxiety, gastrointestinal discomfort such as nausea and vomiting, and epileptic seizures are the most common manifestations. Generalized epileptic seizures usually occur more than once, but status epilepticus is not common. In addition, delirium and hallucinations are also common and serious withdrawal symptoms. The triggering factors of alcohol withdrawal syndrome include overwork, depression, malnutrition and other physical diseases.

3. The treatment goals of alcohol withdrawal syndrome mainly include alleviating alcohol withdrawal symptoms, providing safe withdrawal so that patients are not dependent on drinking, providing humane withdrawal to protect the dignity of patients, and preparing for further treatment after withdrawal.