The early identification of alcohol use disorders and liver injury: proposal for a diagnostic algorithm(129 views) Testino G, Fagoonee S, Caputo F, Pellicano R
Panminerva Med (ISSN: 0031-0808linking, 1827-1898electronic), 2021 Sep; 63(3): 361-367.
Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy - gianni.testino@hsanmartino.it.
Italian Society on Alcohol (SIA), Bologna, Italy - gianni.testino@hsanmartino.it.
Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Torino, Italy.
Unit of Internal Medicine, Cento Hospital, University of Ferrara, Ferrara, Italy.
Unit of Gastroenterology, Molinette Hospital, Torino, Italy.
References: Not available.
The early identification of alcohol use disorders and liver injury: proposal for a diagnostic algorithm
Alcohol use disorders (AUDs) cause 80% of hepatotoxic-related deaths, and approximately 40% of cases of cirrhosis is due to alcohol. The relative risk of developing cirrhosis increases significantly for doses above 60 g/day for men and 20 g/day for women over a period of 10 years. Hence, there is a great opportunity to early detect both AUDs and liver disease, optimizing their management. Such strategy allows patients to be included in a detoxification program in order to achieve total abstinence. Nevertheless, it is crucial to highlight that a great part of patients hospitalized for the first time with cirrhosis or liver failure are not aware to have AUDs. This implies that most of them are diagnosed at an advanced stage. This is more serious considering that about 5% of cirrhotic patients develop hepatocellular carcinoma (HCC). Consequently, this malignancy is diagnosed late. Early detection of fibrosis, is a crucial step in patients with liver disease due to AUDs, influencing treatment and prognosis. Liver biopsy represents the gold standard to diagnose and to stage fibrosis. However, the main limitations of this approach are its invasiveness and its reduced representation of the histological picture. For these reasons, noninvasive methods have been introduced in the latest decade, being the main one elastography, which measure liver stiffness, a parameter directly correlated to liver fibrosis. In this review, we propose an algorithm for early identification of AUDs and liver disease, permitting to early identify HCC and to treat with alcohological programs these patients.
The early identification of alcohol use disorders and liver injury: proposal for a diagnostic algorithm
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