More than a ‘lifestyle’ choice? Does a patient's use of alcohol affect professionals' perceptions of harm and safeguarding responsibilities when it comes to self-neglect? A case study in alcohol-related liver disease

Alcohol-related liver disease (ARLD) is the leading cause of liver disease in the UK, with hospital admissions and deaths continuing to rise. Using a case study that demonstrates a familiar presentation, we consider the challenges and complexities of safeguarding in a patient with alcohol use disorder (AUD) and ARLD, with particular regard to self-neglect. Self-neglect can be a subjective and contentious subject, and, in patients with AUD, it may be interpreted as a lifestyle choice. Hepatology nurses often have regular contact and longstanding relationships with this patient group and thus, as part of the multidisciplinary team, have the potential to play an important role in recognising and escalating safeguarding concerns.

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Confronting the Crisis of Comorbid Alcohol Use Disorder and Alcohol-Related Liver Disease With a Novel Multidisciplinary Clinic

Psychosomatics ◽

10.1016/j.psym.2019.12.004 ◽

2020 ◽

Vol 61 (3) ◽

pp. 238-253

Author(s):

Gerald Scott Winder ◽

Anne C. Fernandez ◽

Kristin Klevering ◽

Jessica L. Mellinger

Keyword(s):

Liver Disease ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Multidisciplinary Clinic ◽

Related Liver Disease

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Gastroenterology

Oxford Assess and Progress: Clinical Medicine ◽

10.1093/oso/9780198812968.003.0011 ◽

2019 ◽

Author(s):

Ricky Sinharay

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Hospital Admissions ◽

Medical Profession ◽

Therapeutic Endoscopy ◽

Chronic Liver ◽

Molecular Events ◽

Related Liver Disease ◽

The Uk ◽

And Function

Gastroenterology and hepatology encompass a vast array of organs that have diverse structure and function and are affected by a multitude of disease processes. Diseases of the digestive tract are a major cause of morbidity and mortality in the United Kingdom (UK) and worldwide. There have been great advances in our understanding, diagnosis, and management of gastrointestinal (GI) disease, and knowledge continues to develop at a great pace. Understanding the physiology and cellular and molecular events that drive pathological processes, as well as the development of sophisticated endoscopic and radiological tests, have transformed diagnostic capability. Therapeutic endoscopy has progressed to replace surgical management of common GI emergencies such as upper GI tract bleeding and decompressing biliary tract obstruction. However, as ever, there is still much work to be done. For example, the advances in biologic immunotherapy in inflammatory bowel disease has greatly improved patients’ quality of life and a reduction in the need for surgery, though the overall impact of these medications on the natural history of the disease is debatable at present. Hepatology is a greatly misunderstood specialty. The physiological changes that occur as cirrhosis and portal hypertension develop are the key to understanding all manifestations of a decompensating liver. Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions have increased. Liver disease is the only major cause of death still increasing year on year, and twice as many people now die from liver disease than in 1991. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol- related liver disease (ARLD) found that less than half the number of patients who died from ARLD received ‘good care’, and avoidable deaths were identified. Allied to this, the enquiry shed light on a cultural pessimism regarding outcomes and prognosis of chronic liver disease and, in particular, ARLD from both the public and the medical profession as a whole. There is now a concerted drive towards improving awareness of chronic liver disease, and initial simple supportive treatments can greatly improve survival, more so than previously thought.

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Genetics and Epigenetics of Aldehyde Dehydrogenase (ALDH2) in Alcohol Related Liver Disease

10.1101/2021.04.16.21255566 ◽

2021 ◽

Author(s):

Bhagyalakshmi Shankarappa ◽

Jayant Mahadevan ◽

Pratima Murthy ◽

Meera Purushottam ◽

Biju Viswanath ◽

...

Keyword(s):

Dna Methylation ◽

Liver Disease ◽

Alcohol Use ◽

Aldehyde Dehydrogenase ◽

Alcohol Use Disorder ◽

College Hospital ◽

Medical College ◽

Icd 10 ◽

Related Liver Disease ◽

Candidate Loci

Alcohol dependence and cirrhosis are key outcomes of excessive alcohol use. We studied the interaction between genetics and epigenetics at the aldehyde dehydrogenase (ALDH2) locus to understand differences in vulnerability to cirrhosis. Individuals were selected according to ICD 10 criteria for Alcohol use disorder with Cirrhosis (AUDC+ve, N=116) and Alcohol use disorder but without Cirrhosis (AUDC-ve, N=123) from the clinical services of Gastroenterology and Psychiatry at the St Johns Medical College Hospital(SJMCH). Fibroscan/sonographic evidence was used to rule out fibrosis for the AUDC-ve group. Genomic DNA from blood was used for genotyping at ALDH2 (rs2238151) locus. A subset of the samples was assessed for DNA methylation (AUDC+ve, N=50; AUDC-ve, N=50) at the LINE-1 and ALDH2 CpG loci by pyrosequencing on a PyroMark Q24. LINE1 DNA methylation did not differ between the groups. ALDH2 DNA methylation was significantly lower in AUDC+ve group compared to AUDC-ve group (P <0.001). Lower methylation in T-allele carriers compared to T-allele non-carriers of the ALDH2 locus (rs2238151) was observed in AUDC+ve subjects(P=0.009). Compromised methylation in blood DNA at candidate loci, in those with liver disease in the context of prolonged severe alcohol abuse, could be explored as a biomarker for current pathology, and further progression.

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Integrating Alcohol Use Disorder Treatment for Pre- and Post- Transplant Care of Patients with Alcohol-Related Liver Disease

International Journal of Integrated Care ◽

10.5334/ijic.s4168 ◽

2021 ◽

Vol 20 (3) ◽

pp. 168

Author(s):

Cathy Heyes

Keyword(s):

Liver Disease ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Post Transplant ◽

Disorder Treatment ◽

Related Liver Disease

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Serum HMGB1 Associates with Liver Disease and Predicts Readmission and Mortality in Patients with Alcohol Use Disorder

Alcohol ◽

10.1016/j.alcohol.2021.05.003 ◽

2021 ◽

Author(s):

Augustin G.L. Vannier ◽

Ben Wardwell ◽

Vladislav Fomin ◽

Amanda Pebenito ◽

Nicholas Wolczynski ◽

...

Keyword(s):

Liver Disease ◽

Alcohol Use ◽

Alcohol Use Disorder

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Dynamic Changes of the Fungal Microbiome in Alcohol Use Disorder

Frontiers in Physiology ◽

10.3389/fphys.2021.699253 ◽

2021 ◽

Vol 12 ◽

Author(s):

Phillipp Hartmann ◽

Sonja Lang ◽

Suling Zeng ◽

Yi Duan ◽

Xinlian Zhang ◽

...

Keyword(s):

Liver Disease ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Serum Levels ◽

Amplicon Sequencing ◽

Dynamic Changes ◽

Alcohol Abstinence ◽

Liver Health ◽

Fungal Microbiome ◽

Progressive Liver Disease

BackgroundAlcohol-associated liver disease (ALD) is an important cause of morbidity and mortality worldwide. The intestinal microbiota is involved in the development and progression of ALD; however, little is known about commensal fungi therein.MethodsWe studied the dynamic changes of the intestinal fungal microbiome, or mycobiome, in 66 patients with alcohol use disorder (AUD) and after 2 weeks of alcohol abstinence using internal transcribed spacer 2 (ITS2) amplicon sequencing of fecal samples.ResultsPatients with AUD had significantly increased abundance of the genera Candida, Debaryomyces, Pichia, Kluyveromyces, and Issatchenkia, and of the species Candida albicans and Candida zeylanoides compared with control subjects. Significantly improved liver health markers caspase-cleaved and intact cytokeratin 18 (CK18-M65) levels and controlled attenuation parameter (CAP) in AUD patients after 2 weeks of alcohol abstinence were associated with significantly lower abundance of the genera Candida, Malassezia, Pichia, Kluyveromyces, Issatchenkia, and the species C. albicans and C. zeylanoides. This was mirrored by significantly higher specific anti-C. albicans immunoglobulin G (IgG) and M (IgM) serum levels in AUD patients in relation to control participants, and significantly decreased anti-C. albicans IgG levels in AUD subjects after 2 weeks of abstinence. The intestinal abundance of the genus Malassezia was significantly higher in AUD subjects with progressive liver disease compared with non-progressive liver disease.ConclusionIn conclusion, improved liver health in AUD patients after alcohol abstinence was associated with lower intestinal abundances of Candida and Malassezia, and lower serum anti-C. albicans IgG levels. Intestinal fungi might serve as a therapeutic target to improve the outcome of patients in ALD.

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