Alcohol abuse may resume after critical surgery

NEW YORK (Reuters Health) - Life-saving surgery to prevent repeated severe bleeding from ruptured veins in the esophagus or upper stomach may not induce some patients with alcoholic liver disease to stop drinking alcohol, researchers report.

Such a surgical procedure may be necessary to reduce the pressure in the veins of the esophagus and upper stomach among patients with cirrhosis, a scarring of the liver frequently caused by alcohol abuse.

The study group consisted of 132 patients with cirrhosis, including 78 with alcoholic liver disease, lead author Dr. Michael R. Lucey, of the University of Wisconsin School of Medicine and Public Health, and colleagues report.

The investigators used patient and family member interviews to determine drinking patterns among 132 cirrhosis patients with who had surgically implanted shunts to reduce the pressure in their esophageal and upper stomach veins.

Twenty to 40 percent of patients with alcoholic liver disease acknowledged alcohol use during 5 years after receiving the pump. About one third of those with alcoholic liver disease reported drinking more than four alcoholic drinks per day during follow-up, the researchers report in the American Journal of Gastroenterology.

The patients with alcoholic liver disease were twice as likely to drink alcohol during follow-up as patients with cirrhosis from other causes.

Continued alcohol use among patient with alcoholic liver disease was associated with a 153 percent increase in gamma-glutamyl transpeptidase (GGT), a liver enzyme indicative of liver disease. These patients also had a significantly increased risk repeat hemorrhage and death.

Lucey and colleagues conclude that a "substantial minority" of patients will return to drinking alcohol after experiencing a life-threatening complication. They recommend that patients with alcoholic liver disease should be encouraged to abstain from alcohol.

SOURCE: American Journal of Gastroenterology, July 2008