Alkohol und gastroenterologische Erkrankungen

Mit einem Alkoholkonsum von nahezu 10 Litern reinem Alkohol pro Kopf der Bevölkerung und pro Jahr nimmt Deutschland eine Spitzenstellung im internationalen Vergleich ein. Dieser Beitrag diskutiert die wesentlichen klinischen Gesichtspunkte der Alkoholschädigung des Gastrointestinaltrakts, des Pankreas und der Leber. Einige Erkrankungen, die durch chronische Alkoholzufuhr ausgelöst oder verschlechtert werden können, werden zusätzlich besprochen.

Schlüsselwörter

alkoholbedingte Krebserkrankungen - alkoholische Pankreatitis - alkoholische Lebererkrankung - Leberzirrhose - alkoholische Hepatitis

• Literatur

• 1 Deutsche Hauptstelle für Suchtfragen (DHS). Jahrbuch Sucht 2019. Lengerich: Pabst Science Publishers; 2020
• 2 Roulot D, Costes JL, Buyck JF. et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2010; 60: 977-984
• 3 Seitz HK, Stickel F. Molecular mechanisms of alcohol-mediated carcinogenesis. Nat Rev Cancer 2007; 7: 599-612
• 4 Seitz HK, Stickel F. Acetaldehyde as an underestimated risk factor for cancer development: role of genetics in ethanol metabolism. Genes Nutr 2010; 5: 121-128
• 5 Homann N, Stickel F, Konig IR. et al. Alcohol dehydrogenase 1C*1 allele is a genetic marker for alcohol-associated cancer in heavy drinkers. Int J Cancer 2006; 118: 1998-2002
• 6 Homann N, Konig IR, Marks M. et al. Alcohol and colorectal cancer: the role of alcohol dehydrogenase 1C polymorphism. Alcohol Clin Exp Res 2009; 33: 551-556
• 7 Egerer G, Stickel F, Seitz HK. Alcohol and gastrointestinal Tract. In: Preedy V. ed. Comprehensive Handbook of Alcohol related Pathology, Vol. 2. London: Elsevier Science; 2005: 557-570
• 8 Teyssen S, Singer MV. Alkohol und Magen. In: Singer MV, Teyssen S. Hrsg. Alkohol und Alkoholfolgekrankheiten. Heidelberg: Springer; 1999: 168-187
• 9 Seitz HK, Bataller R, Cortez-Pinto H. et al. Alcoholic liver disease. Nat Rev Dis Primers 2018; 4: 16
• 10 Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet 2015; 386: 85-96
• 11 Löhr JM, Dominguez-Munoz E, Rosendahl J. et al. HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 2017; 5: 153-199
• 12 Klar E, Werner J. [New pathophysiologic knowledge about acute pancreatitis]. Chirurg 2000; 71: 253-264
• 13 Mayerle J, Sendler M, Hegyi E. et al. Genetics, cell biology, and pathophysiology of pancreatitis. Gastroenterology 2019; 156: 1951-1968
• 14 Kirsten H, Scholz M, Kovacs P. et al. Genetic variants of lipase activity in chronic pancreatitis. Gut 2016; 65: 184-185
• 15 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13 (4 Suppl. 2): e1-e15
• 16 Mayerle J, Anz D, DʼHaese JG. et al. Endoscopic and surgical treatment of chronic pancreatitis. Internist 2019; 60: 235-246
• 17 Blachier M, Leleu H, Peck-Radosavljevic M. et al. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol 2013; 58: 593-608
• 18 Seitz HK, Mueller S. Alcoholic Liver Disease. In: Dancygier H. ed. Clinical Hepatology, Principles and Practice of Hepatobiliary Diseases. Vol. 2. Heidelberg: Springer; 2010: 1111-1152
• 19 Buch S, Stickel F, Trépo E. et al. A genome-wide association study confirms PNPLA3 and identifies TM6SF2 and MBOAT7 as risk loci for alcohol-related cirrhosis. Nat Genet 2015; 47: 1443-1448
• 20 Lammert F. Genetik und Epigenetik alkoholischer Lebererkrankungen. In: Seitz HK, Mueller S. Hrsg. Alkoholische Leber- und Krebserkrankungen. Berlin: De Gruyter; 2019: 67-80
• 21 Stickel F, Hoehn B, Schuppan D. et al. Review article: Nutritional therapy in alcoholic liver disease. Aliment Pharmacol Ther 2003; 18: 357-373
• 22 Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: cofactors for progressive fatty liver disease. J Hepatol 2017; 68: 251-267
• 23 Seitz HK, Mueller S, Hellerbrand C. et al. The effect of chronic alcohol consumption on the development and progression on non-alcoholic fatty liver disease (NAFLD). Hepatobiliary Surg Nutr 2015; 4: 147-151
• 24 Strnad P, Buch S, Hamesch K. Heterozygous carriage of the alpha1-antitrypsin Z variant rs28929474 predisposes to the development of cirrhosis in the presence of alcohol misuse and non-alcohol-related fatty liver disease. J Hepatol 2017; 66: 177
• 25 Mueller S, Millonig G, Seitz HK. Alcoholic liver disease and hepatitis C: a frequently underestimated combination. World J Gastroenterol 2009; 15: 3462-3471
• 26 Thiele M, Rausch V, Fluhr G. et al. Controlled attenuation parameter and alcoholic hepatic steatosis: diagnostic accuracy and role of alcohol detoxification. J Hepatol 2018; 68: 1025-1032
• 27 Sandrin L, Fourquet B, Hasquenoph JM. et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29: 1705-1713
• 28 Mueller S, Millonig G, Sarovska L. et al. Increased liver stiffness in alcoholic liver disease: differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16: 966-972
• 29 Chedid A, Mendenhall CL, Gartside P. et al. Prognostic factors in alcoholic liver disease. VA Cooperative Study Group. Am J Gastroenterol 1991; 86: 210-216
• 30 Maddrey WC, Boitnott JK, Bedine MS. et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978; 75: 193-199
• 31 Sheth M, Riggs M, Patel T. Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis. BMC Gastroenterol 2002; 2: 2
• 32 Forrest EH, Evans CD, Stewart S. et al. Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score. Gut 2005; 54: 1174-1179
• 33 Dominguez M, Rincón D, Abraldes JG. et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol 2008; 103: 2747-2756
• 34 Altamirano J, Miquel R, Katoonizadeh A. et al. A histologic scoring system for prognosis of patients with alcoholic hepatitis. Gastroenterology 2014; 146: 1231-1239
• 35 Mathurin P, OʼGrady J, Carithers RL. et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60: 255-260
• 36 OʼShea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology 2010; 51: 307-328
• 37 Singh S, Murad MH, Chandar AK. et al. Comparative effectiveness of pharmacological interventions for severe alcoholic hepatitis: a systematic review and network meta-analysis. Gastroenterology 2015; 149: 958-970
• 38 Nguyen-Khac E, Thevenot T, Piquet MA. et al. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med 2011; 365: 1781-1789
• 39 Thursz MR, Richardson P, Allison M. et al. Prednisolone of pentoxifylline for alcoholic hepatitis. N Engl J Med 2015; 372: 1619-1628
• 40 Mathurin P, Moreno C, Samuel D. et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med 2011; 365: 1790-1800
• 41 Im GY, Kim-Schluger L, Shenoy A. et al. Early liver transplantation for severe alcoholic hepatitis in the United States – a single experience. Am J Transplant 2016; 16: 841-849
• 42 Lee BP, Chen PH, Haugen C. et al. Three-years results of a pilot programm in early liver transplantation for severe alcoholic hepatitis. Ann Surg 2017; 265: 20-29