![]() Health News - CNN. Colorectal Cancer Overview. Colon cancer and cancer of the rectum can begin as a small polyp, detectable through regular cancer screening, such as colonoscopy. Cohen's 1st Personal Diet Review: Background. Developed by Dr. Cohen (an expert in cardiology and obstetrics and a respected professional in the in vitro. ![]() ![]() Alcoholic Liver Disease . O’Shea, MD, MSCE1, Srinivasan Dasarathy, MD1 and Arthur J. Mc. Cullough, MD1.
Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAm J Gastroenterol 2. November 2. 00. 9Received 2. February 2. 00. 9; accepted 1 April 2. Correspondence: Arthur J. Mc. Cullough, MD, Departmentof Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9. Euclid Avenue, A3. Cleveland, Ohio 4. USA. E- mail: mcculla@ccf. Abstract. These recommendations provide a data- supported approach. ![]() They are based on the following: (i) a formal review and analysis of the recently published world literature on the topic (Medline search); (ii) American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines (1); (iii) guideline policies, including the American Association for the Study of Liver Diseases (AASLD) Policy on the development and use of practice guidelines and the AGA Policy Statement on Guidelines (2); and (iv) the experience of the authors in the specified topic. Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible, in contrast to the standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based on relevant published information. To more fully characterize the quality of evidence supporting the recommendations, the Practice Guideline Committee of the AASLD requires a Class (reflecting the benefit vs. Clinical Guidelines. Authored by a talented group of GI experts, the College is devoted to the development of new ACG guidelines on gastrointestinal and liver diseases. LifeScript.com is a women's health information site which addresses important women's health issues. Minnesota Mom of Two Diagnosed with Cancer Hours After Husband Dies From ALS: 'I'm Not Ready to Give Into It'. It may well represent the oldest form of liver injury known to mankind. Evidence suggests that fermented beverages existed at least as early as the Neolithic period (cir. BC) (5). Alcohol remains a major cause of liver disease worldwide. It is common for patients with ALD to share the risk factors for simultaneous injury from other liver insults (e. Many of the natural history studies of ALD and even treatment trials were performed before these other liver diseases were recognized, or specific testing was possible. Thus, the individual effect of alcohol in some of these studies may have been confounded by the presence of these additional injuries. Despite this limitation, the data regarding ALD are robust enough to draw conclusions about the pathophysiology of this disease. The possible factors that can affect the development of liver injury include the dose, duration, and type of alcohol consumption, drinking patterns, gender, ethnicity, and associated risk factors, including obesity, iron overload, concomitant infection with viral hepatitis, and genetic factors. Geographic variability exists in the patterns of alcohol intake throughout the world (6). Approximately two- thirds of the adult Americans drink alcohol (7). The majority drink small or moderate amounts and do so without evidence of clinical disease (8–1. A subgroup of drinkers, however, drink excessively, develop physical tolerance and withdrawal, and are diagnosed with alcohol dependence (1. A second subset, alcohol abusers and problem drinkers, are those who engage in harmful use of alcohol, which is defined by the development of negative social and health consequences of drinking (e. Failure to recognize alcoholism remains a significant problem and impairs efforts at both the prevention and the management of patients with ALD (1. Although the exact prevalence is unknown, approximately 7. Americans were estimated to meet the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for the diagnosis of alcohol abuse and/or alcohol dependence in 1. In 2. 00. 3, 4. 4% of all deaths from liver disease were attributed to alcohol (1. The population- level mortality from ALD is related to the per capita alcohol consumption obtained from national alcoholic beverage sales data. There are conflicting data regarding a possible lower risk of liver injury in wine drinkers (1. One epidemiological study has estimated that for every 1 l increase in per capita alcohol consumption (independent of the type of beverage), there was a 1. These data must be considered in the context of the limitations of measuring alcohol use and defining ALD. The scientific literature has also used a variety of definitions of what constitutes a standard drink (Table 2). Most studies depend on interviews with patients or their families to quantify drinking patterns, a method that is subject to a number of biases, which may lead to invalid estimates of alcohol consumption (2. Although there are limitations of the available data, the World Health Organization’s Global Alcohol database, which has been in existence since 1. The burden of alcohol- related disease is the highest in the developed world, where it may account for as much as 9. However, even in the developing regions of the world, alcohol accounts for a major portion of the global disease burden, and is projected to take on increasing importance in those regions over time (2. Table 1. Grading system for recommendations. Classification. Description. Class IConditions for which there is evidence and/or general agreement that a given diagnostic evaluation, procedure or treatment is beneficial, useful, and effective. Class IIConditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a diagnostic evaluation, procedure, or treatment. Class IIa. Weight of evidence/opinion is in favor of usefulness/efficacy. Class IIb. Usefulness/efficacy is less well established by evidence/opinion. Class IIIConditions for which there is evidence and/or general agreement that a diagnostic evaluation/ procedure/treatment is not useful/effective and in some cases may be harmful. Level of evidence. Level AData derived from multiple randomized clinical trials or meta- analyses. Level BData derived from a single randomized trial or nonrandomized studies. Level COnly consensus opinion of experts, case studies, or standard of care. Table 2. Quantity of alcohol in a standard drink Amount (g)Range (g)USA1. Canada. 13. 6. 13. UK9. 5. 8–1. 0Europe. Australia and New Zealand. Japan. 23. 5. 21. Adapted from Turner (2. To standardize, many authorities recommend conversion to grams of alcohol consumed. To convert concentrations of alcohol, usually listed in volume percent (equivalent to the volume of solute/volume of solution . These are not necessarily distinct stages of evolution of the disease, but rather, multiple stages that maybe present simultaneously in a given individual (2. These are often grouped into three histological stages of ALD, including fatty liver or simple steatosis, alcoholic hepatitis (AH), and chronic hepatitis with hepatic fibrosis or cirrhosis (2. The latter stages may also be associated with a number of histological changes (which have varying degrees of specificity for ALD), including the presence of Mallory’s hyaline, megamitochondria, or perivenular and perisinusoidal fibrosis (2. Fatty liver develops in about 9. Simple, uncomplicated fatty liver is usually asymptomatic and self- limited, and may be completely reversible with abstinence after about 4–6 weeks (2. However, several studies have suggested that progression to fibrosis and cirrhosis occurs in 5–1. In one study, continued alcohol use (> 4. Fibrosis is believed to start in the perivenular area and is influenced by the amount of alcohol ingested (3. Perivenular fibrosis and deposition of fibronectin occur in 4. Perivenular sclerosis has been identified as a significant and independent risk factor for the progression of alcoholic liver injury to fibrosis or cirrhosis (3. Progression of ALD culminates in the development of cirrhosis, which is usually micronodular, but may occasionally be mixed microand macronodular (3. A subset of patients with ALD will develop severe AH, which has a substantially worse short- term prognosis (3. AH also represents a spectrum of disease, ranging from mild injury to severe, life- threatening injury, and often presents acutely against a background of chronic liver disease (3. The true prevalence is unknown, but histological studies of patients with ALD suggest that AH may be present in as many as 1. Typically, symptomatic patients present with advanced liver disease, with concomitant cirrhosis in more than 5. However, even patients with a relatively mild presentation are at high risk of progressive liver injury, with cirrhosis developing in up to 5. The likelihood that AH will progress to permanent damage is increased among those who continue to abuse alcohol. Abstinence from alcohol in one small series did not guarantee complete recovery. Only 2. 7% of the abstaining patients had histological normalization, whereas 1. AH when followed for up to 1. Risk Factors. Unlike many other hepatotoxins, the likelihood of developing progressive alcohol- induced liver disease or cirrhosis is not completely dose- dependent, as it occurs in only a subset of patients. A number of risk factors that influence the risk of development and progression of liver disease have been identified. The amount of alcohol ingested (independent of the form in which it is ingested) is the most important risk factor for the development of ALD (4. The relationship between the quantity of alcohol ingested and the development of liver disease is not clearly linear (4. However, a significant correlation exists between per capita consumption and the prevalence of cirrhosis (4. The risk of developing cirrhosis increases with the ingestion of > 6. Yet, despite drinking at these levels, only 6–4. In a population- based cohort study of almost 7,0. Italian communities, even among patients with very high daily alcohol intake (> 1. ALD (5. 0). The risk of cirrhosis or non- cirrhotic chronic liver disease increased with a total lifetime alcohol intake of > 1. The odds of developing cirrhosis or lesser degrees of liver disease with a daily alcohol intake of > 3. The type of alcohol consumed may influence the risk of developing liver disease.
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