Alcoholic Liver Disease –why worry?
Alcoholic liver disease remains an important cause of Liver related mortality in India. Chronic intake of large quantities of alcohol causes damage to many organs, the liver being the most often affected one.
Alcoholic liver disease may take the form of chronic illness, initially causing fatty liver followed by chronic hepatitis and subsequently leading to fibrosis (scarring) and cirrhosis. Acute involvement can cause alcoholic hepatitis, which may be life threatening too.
Whereas only fatty liver is a relatively benign illness, the presence of cirrhosis of the liver means major life expectancy shortening. The actual stage of cirrhosis depends on the presence of complications -portal hypertension with bleeding oesophageal varices (vomiting of blood), ascites (distension of abdomen) or hepatic encephalopathy (confusion, coma).
The median survival time of patients with advanced cirrhosis is 6 -18 months. Serious alcoholic hepatitis has a mortality record of up to 50%.
Complete abstinence is absolutely essential for any treatment of alcoholic liver disease, the other therapeutic procedure are of a supportive nature. Steroids can be used in the management of serious alcoholic hepatitis. Cirrhotic patients who demonstrably stop drinking alcohol can be considered for transplantation leading to a markedly prolonged life expectancy.
Am I drinking too much?
The ‘CAGE’ criterion which consists of four questions occurring within a patient’s life time continues to be used commonly as a practical means of screening for alcoholism.
Have you felt the need to Cut down drinking?
Have you ever felt Annoyed by criticism of drinking?
Have you had Guilty feelings about drinking?
Do you ever take a morning Eye opener?
A positive response to at least two questions is seen in the majority of patients with alcoholism and to all four questions in around 50%. In comparison, over 80% of non alcoholics have a negative response to all four questions.