Epidemiology of Alcohol Use and Its Gastrointestinal Complications

The relationship between the average daily intake of alcohol and the risk of developing chronic pancreatitis was studied in two surveys, one in Marseille (France), the other in 9 centers, in Caucasian-populated countries. In the latter survey, the interactions between alcohol, protein and fat consumption and the risk of chronic pancreatitis have also been statistically analyzed. These studies were performed with hierarchical log-linear models for contingency tables, the relative odds being taken as an approximation of the relative risk. It has been shown that there is no apparent threshold of toxicity of alcohol on the human pancreas. The logarithm of the relative risk of chronic pancreatitis increases linearly as a function of the quantity of alcohol and protein consumed, and varies quadratically as a function of average daily lipid intake (a low- or high-lipid diet increases the risk of developing chronic pancreatitis in comparison to an average-fat diet (85–110 g fat per day). The effects on log-relative risk of alcohol, fat and protein daily consumption are additive. In Marseille, the average duration of alcohol consumption before the appearance of symptoms is 18 ± 11 years for males and 11 ± 8 years for females, which is much shorter than the duration of alcohol consumption before onset of symptoms in cirrhotic patients. Show more

A total of 512 people from a defined population in west Birmingham served by a district general hospital were found to have cirrhosis in the period 1959-76. The annual incidence rose from 5.6 per 100 000 to a peak of 15.3 per 100 000 in 1974. This was due to an increase in the incidence of alcoholic cirrhosis, which in the last six years accounted for two-thirds of cases. The proportion of patients with decompensated cirrhosis when first seen (65%) did not alter during the 18 years. This was reflected in a death rate of 78% among the 468 patients traced up to the end of 1978. Liver failure, hepatoma, and gastrointestinal haemorrhage accounted for almost three-quarters of the deaths. The proportion of patients who survived for five years was 36% for alcoholic cirrhosis, 14% for cryptogenic cirrhosis, and 60% for chronic active hepatitis, and these figures too remained constant throughout the 18 years. Modern methods of treatment for decompensated cirrhosis did not improve prognosis and only abstention in patients with alcoholic cirrhosis had a beneficial effect on survival. Since alcoholic cirrhosis is now the most common form of the disease it is important to recognise those at risk and to encourage abstinence; also, more efforts are needed to identify the causes of cryptogenic cirrhosis. Whatever the cause, cirrhosis needs to be diagnosed before decompensation occurs, if treatment is to have any effect. Show more

The average daily alcohol consumption of 184 male patients with ascitic cirrhosis and a random population sample of 778 males was ascertained by interview. Relative risks of ascitic cirrhosis are calculated for different levels of daily alcohol consumption: the logarithm of risk is shown to be a linear function of consumption. The proportion of cases attributable to alcohol is calculated and shown to be over 90%. The potential saving of ascitic cirrhosis if individual consumption of alcohol does not exceed 40g. per day is estimated at 80%. Show more