People with these 3 situations pay attention!

It is only for medical professionals to read for reference.
Severe drinkers, moderate drinkers, and special populations should pay attention to early screening! The "Report on the Global State of Alcohol and Health" released by the World Health Organization (WHO) on September 21, 2018 pointed out that in 2016, more than 3 million people died from harmful use of alcohol, accounting for 5.
3% of the total global deaths; on a global scale Within, about 50% of liver cirrhosis is caused by alcohol [1].

China has a long history of wine culture, and the current prevalence of alcoholic liver disease (ALD) in my country has reached 4.
5% [2].

The real disease burden of ALD may be higher than the existing estimated data.
It is particularly important to pay attention to the recognition, screening, diagnosis and treatment of early ALD.

From 03:30-05:00 on May 24, 2021, Beijing time, the American Digestive Disease Week (DDW) held a theme meeting on early ALD screening and diagnosis.

This conference was hosted and introduced by the associate editor of Journal of Hepatology, Professor Vijay Shah from Mayo Medical Center and Professor Ashwani K.
Singal from Sanford School of Medicine, University of South Dakota.
Experts focused on the hazards of early ALD.
, Screening methods, liver pathological characteristics and other aspects of the progress were shared and exchanged.

"Digestive Liver Disease Channel of the Medical Circle" specially invited Dr.
Fan Xiaoli from the Department of Gastroenterology, West China Hospital of Sichuan University to bring us wonderful conference reports.

1.
Youth, women and obese people need to be vigilant First of all, Professor Vijay Shah shared the epidemiological research progress of ALD in recent years.

A cross-sectional analysis of global liver disease patients found that 31% of patients with early liver disease caused by a single cause were HCV infection, 21% were HBV infection, and 17% were non-alcoholic fatty liver disease (NAFLD), but only 3.
8 % Is diagnosed as ALD. In contrast, 29% of patients with advanced liver disease have ALD [3].

Therefore, most patients are diagnosed late.

A study in 2018 analyzed the trend of cirrhosis and liver cancer-related deaths in adults in the United States from 1999 to 2016 [4], and found that the 25-34-year-old population has the fastest annual growth rate of cirrhosis-related mortality (10.
5%) And this part of the population mostly died of alcoholic cirrhosis.

In addition to adolescents, the dangers of women in ALD have also received more attention in recent years.

It has been clear in the past that women are more sensitive to alcohol than men.

The study found that although more men than women died of liver cirrhosis and liver cancer, the increase in mortality related to liver cirrhosis and liver cancer was similar between men and women [4].

A study published in the American Journal of Gastroenterology in 2020 also found that the proportion of female ALD patients in the liver transplant list has increased through analysis of 3 large databases in the United States [5].

A study in the journal Nature Reviews Gastroenterology & Hepatology in 2018 summarized the results of clinical and basic research on gender in ALD in recent years.
It is recommended that women limit their drinking to 14 grams per day and abstain from alcohol for at least two days a week.
It also calls for future clinical trials.
In practice, the clinical management of ALD needs to pay attention to gender differences and strengthen public education [6].

In addition, most studies have shown that a small amount of alcohol can benefit healthy people, but obesity and ALD can have a negative impact on each other.

Therefore, it is recommended that patients with NASH should reduce their alcohol intake, and patients with ALD should also pay attention to the management of body mass and NASH risk factors.

2.
People who have these 3 factors are at risk and should be screened early.
The team of Professor Ramon Bataller from the University of Pittsburgh School of Medicine will next introduce the center's research. The team established the Attention-to-Burden Index (ABI), compared the research development of liver diseases of different causes from 2010 to 2014, and estimated the disease burden of the four major liver diseases.
The resulting ratio reflects the Whether the research on liver disease of this kind of etiology is over-focused (positive value) or under-focused (negative value).

The results suggest that the average research attention rates of hepatitis B and C are 31% and 47%, respectively, and the average research attention rates of NAFLD and ALD are 17% and 5%, respectively; the total burden of hepatitis B and hepatitis C are respectively At 5% and 28%, the total burden of NAFLD and ALD is 17% and 50%, respectively.

The calculated ABI index of hepatitis B and hepatitis C are +6.
7 times and +1.
7 times, respectively.

Compared with the load, the ABI index is -9.
7 times, suggesting that the academic circles have paid insufficient attention to the research of ALD [7].

Therefore, Professor Ramon Bataller called for increased attention to ALD and increased screening of high-risk groups.

What are the factors that need to be screened early? Professor Ramon Bataller pointed out that people with the following conditions should be screened early: (1) heavy drinkers (>40g/d); (2) moderate drinkers (20-40g/d) with metabolic syndrome, presence and Alcohol abuse and alcohol-induced liver damage are closely related to genes such as PNPLA3 gene mutations, and the risk of weekend alcohol abusers is increased; (3) Special populations, such as past obesity surgery and family alcohol drinkers.

The means of early screening mainly include: physical examination, questioning patients or relatives and friends, alcohol use disorder screening scale (AUDIT), laboratory and biomarker testing, etc.

3.
Pay attention to the severity of histology.
Alcohol-related steatohepatitis that requires hospitalization is the most dangerous.
Next, Dr.
Nitzan C Roth from Northwell Medical Center in New York pointed out that the liver pathological features of early ALD mainly include steatosis and foam degeneration.
, Steatohepatitis, perisinus fibrosis, etc.
, need to pay attention to identification.

The histological severity of ALD is related to its prognosis.
It is recommended to stratify patients according to histological severity. A systematic review published in the Journal of Hepatology in 2019 included 37 studies with 7,528 participants and found that among dangerous drinkers, 27% had liver steatosis, 24% had steatohepatitis, and 26% had liver cirrhosis.

In patients with normal histology, the annual rate of progression to cirrhosis is 1%, hepatic steatosis is 3%, steatohepatitis is 10%, and fibrosis is 8%.

The annual mortality rate for steatosis patients is 6%, and the annual mortality rate for patients with cirrhosis is 8%.

Among biopsy patients with steatohepatitis, the annual mortality rate of the inpatient cohort is 15%, which is higher than that of the mixed cohort of inpatients and outpatients (5% annual mortality), suggesting that the alcohol-related steatohepatitis requiring hospitalization is ALD The most dangerous subtype [8].

A study published in the Gut journal in 2020 included the death risk of more than 3,453 biopsy-proven ALD patients in Sweden from 1969 to 2017.
It was found that the total mortality rate of ALD patients was 90.
9 persons/1000 during the entire study period.
Person-years, while the total mortality rate of the control healthy population is 20.
1/1000 person-years.

ALD patients with liver cirrhosis have the highest risk of death (aHR=6.
07, 95%CI 5.
43-6.
77), while ALD patients without liver cirrhosis also have a significant increase in mortality, and are highest in the first year after baseline, but at ≥ After 10 years of follow-up, it continued to increase (aHR=2.
74, 95%CI 2.
37-3.
16) [9].

Finally, Professor Ashwani K.
Singal summarized the value of non-invasive serum biomarkers and liver stiffness measurement in the diagnosis and prognosis of ALD patients.
Most non-invasive examination methods are not effective in ALD patients and call for future research.
Pay attention to the value of MRE in ALD and the value of non-invasive biomarkers for judging the prognosis of ALD.

In summary, the current global disease burden of ALD is still heavy and needs more attention.

Early screening and treatment of at-risk populations is of great significance to prevent disease progression and improve prognosis, with particular attention to young people, women, and obese people.

Finally, although liver biopsy is invasive, it is very important for differential diagnosis and prognosis, and more research is needed in this area.

 Expert profile Yang Li, director of the Department of Gastroenterology/Endoscopy Center, West China Hospital, Sichuan University, Sichuan University-West China Gastrointestinal Tumor Center, University of Oxford, Chinese Director, Professor/Chief Physician, and Doctoral Supervisor Specializing in the clinical treatment of difficult and severe digestive system diseases, especially liver cirrhosis and autoimmune liver disease Diagnosis and treatment and basic research.

Undertook a number of topics including the National Natural Science Foundation of China.

Published more than 50 SCI papers in Hepatology, Radiology and other journals.

As the first complete person, he won the first prize of Sichuan Science and Technology Progress Award in 2019.

Associate editor of the national textbooks "Digestive Medicine" and "Digestive System and Diseases".

Member of the editorial board of "Chinese Journal of Hepatology", "Journal of Sichuan University (Medical Edition)" and other journals.

Evaluation expert of the National Natural Science Foundation of China.

Member of the Hepatology Branch of the Chinese Medical Association, Member of the Gastroenterologists Branch of the Chinese Medical Doctor Association, Deputy Leader of the Cirrhosis Chemistry Group of the Society of Hepatology of the Chinese Medical Association, Deputy Leader of the Imaging Collaboration Group of the Chinese Society of Digestive Endoscopy, No.
7 of the Sichuan Medical Association Chairman of the Digestive Specialty Committee, President-elect of the Digestive Physician Branch of the Sichuan Medical Association, Executive Standing Committee Member of the Chinese Branch of International Esophageal Diseases. Reference materials: [1]World Health Organization.
Global Status report on alcohol and health.
2018.
[2]XIAO J,WANG F,WONG NK,et al.
Global liver disease burdens and research trends:Analysis from a Chinese perspective[J].
Journal of hepatology,2019,71(1):212-21.
[3] 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[J].
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association,2019,17(11):2320-9.
e12.
[4]TAPPER EB,PARIKH N D.
Mortality due to cirrhosis and liver cancer in the United States,1999-2016: observational study[J].
BMJ( Clinical research ed),2018,362(k2817.
[5]DANG K,HIRODE G,SINGAL AK,et al.
Alcoholic Liver Disease Epidemiology in the United States: