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Mistakes in alcoholic liver disease and how to avoid them

Helena Cortez-Pinto, Pedro Marques Da Costa

Summary

AI Generated

Alcohol consumption is the most prevalent cause of liver cirrhosis in Europe and the third leading risk factor for overall mortality, accounting for approximately half a million deaths annually worldwide.

  • Alcoholic liver cirrhosis represents 50% of all cirrhosis cases globally according to the World Health Organization.
  • Alcoholic liver disease is multifaceted with several cofactors influencing its progression.
  • Patients with alcohol abuse can simultaneously have viral hepatitis B or C, alpha-1 antitrypsin deficiency, or haemochromatosis.
  • This material provides epidemiological context on the burden of alcohol-related liver disease in Europe and globally.
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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Alcohol consumption is the most prevalent aetiology for liver cirrhosis in Europe and the third leading risk factor for overall mortality.1,2 In fact, alcoholic liver cirrhosis accounts for almost half a million deaths a year worldwide, corresponding to 50% of all cases of cirrhosis, according to the World Health Organization (WHO).3 Alcoholic liver disease (ALD) is multifaceted, with several cofactors influencing its progression. Patients abusing alcohol can simultaneously have viral hepatitis B or C, or a genetic disease, such as alpha-1 antitrypsin deficiency or haemochromatosis.

Topics

Hepatobiliary

Citation

Marques da Costa P and Cortez-Pinto H. Mistakes in alcoholic liver disease and how to avoid them. UEG Education 2017: 17; 10–14.

Published

2024

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UEG Mistakes In Articles
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Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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UEG Mistakes In Articles
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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Summary

AI Generated

Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in opportunistic infections and vaccinations in IBD and how to avoid them

Paul McLellan, Julien Kirchgesner

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

The introduction and general use of new immunosuppressive agents, including biologic agents and small molecules, has revolutionised the therapeutic management of inflammatory bowel disease (IBD). Such immunosuppression may expose patients to opportunistic infections, which can be challenging to recognise. These infections are crucial due to their association with morbidity or mortality and the challenges regarding effective treatment. New evidence in this field and vaccination strategies for immunosuppressed IBD patients led to updated European Crohn’s and Colitis Organization (ECCO) guidelines in 2021. Here we discuss the errors to avoid when managing the risk of opportunistic infections in IBD patients. The discussion is based on evidence, whenever possible, and our clinical experience.


Topics

IBD

Citation

Kirchgesner J and McLellan P. Mistakes in opportunistic infections and vaccinations in IBD and how to avoid them. UEG Education 2022; 22: 26–28.

Published

2022

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UEG Mistakes In Articles
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Mistakes in therapeutic drug monitoring of biologics in IBD and how to avoid them

Adam Cheifetz, Konstantinos Papamichail

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Biological therapy has revolutionised the treatment of moderate to severe inflammatory bowel disease (IBD), namely Crohn’s disease (CD) and ulcerative colitis (UC). However, up to one-third of patients with IBD are primary non-responders, and up to half can lose response over time.These unwanted outcomes can be explained by either pharmacodynamic (mechanistic failure) or pharmacokinetic (PK) issues with or without the development of anti-drug antibodies (ADA), so-called immunogenicity.1 Reactive therapeutic drug monitoring (TDM), defined as the measurement of drug concentrations and anti-drug antibody (ADA) levels in the setting of primary non-response (PNR) or secondary loss of response (SLR), can help to explain better and manage these unwanted outcomes. However, it would make sense to try to prevent PNR and SLR by routinely measuring drug concentrations and ADA to achieve and maintain a targeted therapeutic drug concentration, the so-called proactive TDM. Here we discuss some common mistakes and significant errors to avoid when utilising TDM of biologics in patients with IBD. The discussion is based on evidence, whenever possible, and our clinical experience and perception of the field.

Topics

IBD

Citation

Konstantinos Papamichail and Adam S. Cheifetz. Mistakes in therapeutic drug monitoring of biologics in IBD and how to avoid them. UEG Education 2023; 23: 13-18.

Published

2023

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in acute diverticulitis and how to avoid them

Anna A.W. van Geloven, Simone Rottier, Marja A. Boermeester

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

Acute diverticulitis is an inflammatory complication of diverticulosis and can either be uncomplicated or complicated. Making the distinction between uncomplicated and complicated acute diverticulitis is essential because treatment strategies differ between the two. Here, we discuss 10 mistakes frequently made when managing patients with acute diverticulitis. We focus on using the correct terminology, diagnostic preference and several treatment options, such as omitting or administering antibiotics, radiological interventions and various aspects of surgery. Acute diverticulitis is an important topic because its incidence is rising worldwide and it is becoming a considerable burden on healthcare systems. Most of the discussion included here is evidence-based, supplemented with many years’ combined clinical experience where evidence is lacking.

Topics

Endoscopy Radiology & Imaging Surgery

Citation

Cite this article as: Rottier SJ, et al. Mistakes in acute diverticulitis and how to avoid them. UEG Education 2019; 19: 31–35.

Published

2019

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Mistakes in cases on call and how to avoid them

Mistakes in cases on call and how to avoid them

Marine Camus Marine Camus, Xavier Dray

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Mistakes in cases on call and how to avoid them

Xavier Dray, Marine Camus

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, https://iris.who.int/handle/10665/274603 (2018, accessed 19 August 2024).
2.
European Association for the Study of the Liver. HEPAHEALTH Project Report. EASL, https://easl.eu/publication/hepahealth-project-report/ (2018, accessed 19 August 2024).
3.
Parker R, Aithal GP, Becker U, et al. Natural history of histologically proven alcohol-related liver disease: A systematic review. J Hepatol 2019; 71: 586–593.
4.
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59: 160–168.
5.
Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med 2015; 278: 238–250.
6.
Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer 2015; 112: 580–593.
7.
Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69: 154–181.
8.
Amonker S, Houshmand A, Hinkson A, et al. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7: e0133.
9.
Masson S, Emmerson I, Henderson E, et al. Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease. Liver Int 2014; 34: 235–242.
10.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption‐II. Addiction 1993; 88: 791–804.
11.
Bush K. The AUDIT Alcohol Consumption Questions (AUDIT-C)An Effective Brief Screening Test for Problem Drinking. Arch Intern Med 1998; 158: 1789.
12.
Gough G, Heathers L, Puckett D, et al. The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice. Alcohol Clin Exp Res 2015; 39: 1493–1500.
13.
Reynaud M, Schellenberg F, Loisequx‐Meunier M, et al. Objective Diagnosis of Alcohol Abuse: Compared Values of Carbohydrate‐Deficient Transferrin (CDT), γ‐Glutamyl Transferase (GGT), and Mean Corpuscular Volume (MCV). Alcohol Clin Exp Res 2000; 24: 1414–1419.
14.
Innes H, Morling JR, Aspinall EA, et al. Late diagnosis of chronic liver disease in a community cohort (UK biobank): determinants and impact on subsequent survival. Public Health 2020; 187: 165–171.
15.
Shah ND, Ventura-Cots M, Abraldes JG, et al. Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide. Clin Gastroenterol Hepatol 2019; 17: 2320-2329.e12.
16.
National Institute for Health and Care Excellence NICE. Cirrhosis in over 16s: assessment and management, https://www.nice.org.uk/guidance/ng50/chapter/Recommendations#diagnosis (2016).
17.
Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. The Lancet 2017; 389: 1558–1580.
18.
Hofer BS, Simbrunner B, Hartl L, et al. Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis. Clin Gastroenterol Hepatol 2023; 21: 2308-2317.e7.
19.
Degré D, Stauber RE, Englebert G, et al. Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey’s discriminant function <32. J Hepatol 2020; 72: 636–642.
20.
Helander A, Hansson T. The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment. Scand J Clin Lab Invest 2023; 83: 424–431.
21.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157: 645.
22.
O’Donnell A, Anderson P, Newbury-Birch D, et al. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of Reviews. Alcohol Alcohol 2014; 49: 66–78.
23.
Kiefer F, Mann K. Acamprosate: How, Where, and for Whom Does it Work? Mechanism of Action, Treatment Targets, and Individualized Therapy. Curr Pharm Des 2010; 16: 2098–2102.
24.
Van Den Brink W, Aubin H-J, Bladstrom A, et al. Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies. Alcohol Alcohol 2013; 48: 570–578.
25.
Stockwell T, Zhao J, Martin G, et al. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions. Am J Public Health 2013; 103: 2014–2020.
26.
Kilian C, Lemp JM, Llamosas-Falcón L, et al. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101996.
27.
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization, https://iris.who.int/handle/10665/148114 (2014, accessed 19 August 2024).
28.
Levin DM, Baker AL, Riddell RH, et al. Nonalcoholic liver disease. Am J Med 1979; 66: 429–434.
29.
Lazarus JV, Newsome PN, Francque SM, et al. Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2024; 79: E93–E94.
30.
Luo N, Zhang X, Huang J, et al. Prevalence of steatotic liver disease and associated fibrosis in the United States: Results from NHANES 2017-March 2020. J Hepatol 2024; 80: e70–e71.
31.
Nasr P, Wester A, Ekstedt M, et al. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 1048-1057.e2.
32.
Fletcher L, Halliday J, Powell L. Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin. J Gastroenterol Hepatol 1999; 14: 202–214.
33.
Bell H, Skinningsrud A, Raknerud N, et al. Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases. J Intern Med 1994; 236: 315–322.
34.
Costa-Matos L, Batista P, Monteiro N, et al. Liver hepcidin mRNA expression is inappropriately low in alcoholic patients compared with healthy controls: Eur J Gastroenterol Hepatol 2012; 24: 1158–1165.
35.
Machado MV, Ravasco P, Martins A, et al. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15: 106.
36.
Fletcher LM, Dixon JL, Purdie DM, et al. Excess alcohol greatly increases the prevalence of cirrhosis in hereditary hemochromatosis. Gastroenterology 2002; 122: 281–289.
37.
Mueller S. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966.
38.
Trabut J, Thépot V, Nalpas B, et al. Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers. Alcohol Clin Exp Res 2012; 36: 1407–1411.
39.
Mueller S. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20: 14626.
40.
Fernandez M, Trépo E, Degré D, et al. Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease: Eur J Gastroenterol Hepatol 2015; 27: 1074–1079.
41.
Chin JL, Chan G, Ryan JD. Noninvasive Assessment of Liver Fibrosis and Cirrhosis With Ultrasound-based Elastography in Alcohol-related Liver Disease. Gastroenterology 2016; 150: 1251–1252.
42.
Lebrec D, Benhamou J-P. Noncirrhotic Intrahepatic Portal Hypertension. Semin Liver Dis 1986; 6: 332–340.
43.
Smith C, Gasparetto M, Jordan C, et al. The Effects of Alcohol and Aldehyde Dehydrogenases on Disorders of Hematopoiesis. In: Vasiliou V, Zakhari S, Seitz HK, et al. (eds) Biological Basis of Alcohol-Induced Cancer. Cham: Springer International Publishing, pp. 349–359.
44.
Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561–1569.
45.
Elphick DA, Dube AK, McFarlane E, et al. Spectrum of Liver Histology in Presumed Decompensated Alcoholic Liver Disease. Am J Gastroenterol 2007; 102: 780–788.
46.
Hardy T, Wells C, Kendrick S, et al. White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol 2013; 13: 55.
47.
Broekhoven AGC, Ostyn T, Van Melkebeke L, et al. Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure. Scand J Gastroenterol 2024; 59: 577–583.
48.
Altamirano J, Miquel R, Katoonizadeh A, et al. A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis. Gastroenterology 2014; 146: 1231-1239.e6.
49.
Imperiale TF. Do Corticosteroids Reduce Mortality from Alcoholic Hepatitis?: A Meta-analysis of the Randomized Trials. Ann Intern Med 1990; 113: 299.
50.
Singh S, Murad MH, Chandar AK, et al. Comparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis. Gastroenterology 2015; 149: 958-970.e12.
51.
Imperiale TF, O’Connor J (Barry), McCullough AJ. Corticosteroids Are Effective in Patients With Severe Alcoholic Hepatitis. Am J Gastroenterol 1999; 94: 3066–3068.
52.
Louvet A, Labreuche J, Artru F, et al. Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis. Gastroenterology 2015; 149: 398-406.e8.
53.
Mathurin P, O’Grady J, Carithers RL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255–260.
54.
Louvet A, Naveau S, Abdelnour M, et al. The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45: 1348–1354.
55.
Foncea CG, Sporea I, Lupușoru R, et al. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10: 2338.
56.
Thursz MR, Richardson P, Allison M, et al. Prednisolone or Pentoxifylline for Alcoholic Hepatitis. N Engl J Med 2015; 372: 1619–1628.
57.
Louvet A, Wartel F, Castel H, et al. Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor. Gastroenterology 2009; 137: 541–548.
58.
Louvet A, Labreuche J, Dao T, et al. Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial. JAMA 2023; 329: 1558.
59.
Mendenhall CL, Moritz TE, Roselle GA, et al. Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment. J Parenter Enter Nutr 1995; 19: 258–265.
60.
McClain CJ, Barve SS, Barve A, et al. Alcoholic Liver Disease and Malnutrition. Alcohol Clin Exp Res 2011; 35: 815–820.
61.
Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol 2020; 26: 2916–2930.
62.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193.
63.
Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences: Curr Opin Clin Nutr Metab Care 2008; 11: 693–700.
64.
McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018; 23: 156–161.
65.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61: 1735–1743.
66.
Locklear CT, Golabi P, Gerber L, et al. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97: e12774.

Abstract

It is a difficult task and a great responsibility to evaluate and manage patients with acute - and potentially life-threatening - clinical presentations. It is even more complex to achieve high standards of care for cases on call. Indeed, on-call gastroenterologists, hepatologists and endoscopists are faced with a wide and protean range of gastrointestinal, liver and pancreatic emergencies.  The decision-making process for cases on call is mainly based on information received over the phone, on medical knowledge and clinical experience, and on the resources available. As the degree of confidence in any information given on call may vary, it is of tremendous importance to note, and to document, with precise timing, what has been communicated by, proposed to, and eventually decided with, multiple caregivers (i.e. nurses, emergency physicians, intensive care physicians, surgeons, radiologists etc.)

Topics

Endoscopy Surgery

Citation

Dray X and Marteau P. Mistakes in cases on call and how to avoid them. UEG Education 2017; 17: 30–32

Published

2024

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Mistakes in cases on call and how to avoid them

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Marine Camus Marine Camus, Xavier Dray

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