FULL TEXT: http://www.medscape.com/viewarticle/577881?src=mp&spon=20&uac=31238BR

From The American Journal of Gastroenterology
Alcohol Consumption by Cirrhotic Subjects: Patterns of Use and Effects on Liver
Function
Posted 09/25/2008

Michael R. Lucey, M.D.; Jason T. Connor, Ph.D.; Thomas D. Boyer, M.D.; J.
Michael Henderson, M.D.; Layton F. Rikkers, M.D.; and the DIVERT Study Group

Abstract and Introduction
Abstract
Objective: We investigated patterns of use of alcohol and its clinical effects
among cirrhotic subjects who participated in a randomized clinical trial
comparing the efficacy of transjugular intravenous portosystemic shunt and
distal splenorenal shunt.
Methods: There were 132 cirrhotic subjects, 78 with alcoholic liver disease
(ALD), who were followed for a median of 49 months (range 2–93 months). Alcohol
use was assessed by patient questionnaire, with corroboration by family members.
Results: Twenty-eight subjects (21%) were drinking at study entry and 60
subjects (45%) drank during follow-up. Heavy drinking (>4 drinks/day) was
recorded in 25 ALD subjects, but in no non-ALD subjects (P < 0.0001). Drinking
by ALD subjects was associated with a 153% increase in gamma-glutamyl
transpeptidase (GGT) (P < 0.0001). The frequencies of death (46% vs 30%),
ascites (33% vs 20%), encephalopathy (56% vs 42%), and variceal bleeding (11% vs
3%) were greater in the ALD group. In a Cox proportional hazards model only
"ever heavy drinking" was associated with death (P = 0.0099), while recent heavy
drinking increased the hazard of variceal hemorrhage dramatically (odds ratio
10.85).
Conclusions: Whereas most cirrhotic subjects, alcoholic or not, did not drink
during 5 yr of observation, heavy alcohol use occurred exclusively in ALD
patients. Alcohol use by ALD subjects was associated with elevations in GGT and
was linked to death and with rebleeding from shunt dysfunction.

Introduction
The impact of alcohol consumption on the outcome of alcoholic cirrhosis remains
controversial.[1, 2] Difficulty in follow-up, in verifying data on alcohol use,
and the confounding effects of portal hypertension limit many studies.[3,4]
Most, but not all, studies indicate that continued alcohol use by patients with
alcoholic liver disease (ALD) is associated with increased mortality.[1,2,5-10]
In particular, it remains uncertain whether alcohol use is temporally associated
with increases in portal pressure or initiation of variceal hemorrhage.[11-14]

The Decompression Intervention of Variceal Rebleeding Trial (DIVERT) study is a
randomized controlled trial (RCT) comparing the efficacy of transjugular
intravenous portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) in
patients with cirrhosis of any cause who had failed pharmacological or
endoscopic therapy for variceal hemorrhage.[15] All subjects, alcoholic and
nonalcoholic alike, were interviewed about alcohol use at regular intervals
throughout the study. Consequently, the DIVERT study data set provides an
exceptional opportunity to explore the effects of alcohol use by patients with
cirrhosis. Our purpose in the present article is to investigate patterns of
alcohol use revealed by the prospective DIVERT database and to analyze the
effect of alcohol use on liver function and decompensation in this population of
cirrhotics who carried a minimal risk of further variceal bleeding.