Alcohol Related Diseases in Gastroenterology

432 Pages·1985·13.91 MB·English

by  W. K. Lelbach (auth.)

Alcohol Related
Diseases in
Gastroenterology
Edited by
H. K. Seitz and B. Kommerell
With 71 Figures and 38 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo
Priv. Doz. Dr. med. Helmut Karl Seitz
Professor Dr. med. Burkhard Kommerell
Medizinische Universitatsklinik Heidelberg
Innere Medizin IV (Gastroenterologie)
Bergheimer Strasse 58
D-6900 Heidelberg 1
Cover photograph:
Evidence of excessive alcohol consumption in early Egypt. These hieroglyphics,
with English subtitles, are taken from "The Precept of Ani" - a papyrus of
etiquette, which dates from about 1500 B.C.
(Cited by H. O. Conn (1982) Cirrhosis. In: SchiffL, Schiff ER (eds) Diseases
of the Liver. Lippincott, Philadelphia, 847-978)
ISBN-13:978-3-642-70050-7 e-ISBN-13:978-3-642-70048-4
DOl: 10.1007/978-3-642-70048-4
Library of Congress Cataloging in Publication Data.
Main entry under title. Alcohol related diseases in gastroenterology. Includes
bibliographies and index. 1. Gastrointestinal system,...Diseases. 2. Alcoholism
Complications and sequelae. 3. Alcohol-Toxicology. 4. Liver-Diseases. I. Seitz,
H. K. (Helmut Karl), 1950. II. Kommerell, B. [DNLM: 1. Alcohol, Ethyl
pharmacodynamics. 2. Alcoholism-complications. 3. Gastrointestinal System
drug effects. 4. Liver Diseases, Alcoholic. [QV84A3546j RC802.A361985
616.3'385-2788 ISBN -13: 978-3-642-70050-7 (U. S.)
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© Springer-Verlag Berlin Heidelberg 1985
Softcover reprint of the hardcover 1st edition 1985
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2123/3140-543210
To Charles S. Lieber
and
To our Wives
However, if someone asks - to what purpose should we help one
another, make life easier for each other, make beautiful music or
have inspired thoughts? - he would have to be told: If you don't feel
it, no-one can explain it to you.
A. Einstein
Foreword
Alcohol abuse ranks among the most common and also the most
severe environmental hazards to human health. Its significance is
heightened by the possibility of prevention by elimination of the
habit, however, rarely exerted. The incidence of deleterious effects
on human health has relentlessly risen in the past years for a variety
of factors. They include migration of populations and, particularly,
increased urbanization. Thus, in some parts of the world, population
groups previously spared have become involved, which is also re
flected in the increasing number of breweries and distilleries in the
developing countries. Social, religious, and gender-related barriers
to alcohol consumption are loosening, and the financial improvement
of some segments of populations now enable them to buy alcoholic
beverages. Thus the greatest percentage rise in the United States
has recently been in black women. Adolescents and young people
drink more alcoholic beverages than ever, and growing alcohol abuse
by pregnant women has let to an increase of the incidence of the
fetal alcohol syndrome.
While the social and behavioral, including psychiatric, consequences
of alcoholism are staggering, the gastrointestinal and, particularly,
hepatic manifestations are the most widespread somatic effects, and
chronic hepatic disease in alcoholics appears to cause the greatest
cost to society. Indeed, mortality from liver cirrhosis is considered
a reliable index of alcohol consumption in a country. No wonder
that the gastrointestinal and, again especially, hepatic manifestations
of alcoholism continue to attract great interest from both practical
and academic points of view, and call for repeated review of available
information.
This book represents a new attempt to marshal existing information
and to look at it, at least in part, from a new perspective. It thus
supplements a number of preceding reviews and monographs.
Scholarly presentation is guaranted by the excellence of the con
tributors from various countries in Europe and North America and
from Japan. All have written authoritatively on their subjects before,
and some are authors of previous monographs on the medical dis
orders of alcoholism in general and its hepatic manifestations. Taking
VIII Foreword
stock anew of gastrointestinal problems related to alcohol increases
the knowledge in the field and spreads it to wider circles. This, in
itself, is a first step in improved management of a health hazard
of growing, indeed alarming dimensions. Thus, we find new data
on the extent of the problem by epidemiologic studies and learn
of its geographic variations; for instance, in Japan alcoholic liver
disease seems to have increased to a conspicuous degree in the last
decade. Information is also being offered on a series of unresolved
questions in the management of the multifold gastrointestinal dis
orders related to alcohol abuse. To list some of both clinical and
investigative interest, the character of the predisposition to alcoholism
as well as to the progression of the diseases in alcoholics are still
not established. The recognition of the diseases and their differential
diagnostic separation from other diseases, which may even complicate
the alcoholic disorders, remain a problem. The pathogenesis of the
consequences exemplified by carcinomatous transformation, par
ticularly of the liver, is still not clear. The recognition of continued
alcohol abuse by laboratory tests has significantly advanced but is
not yet established. Some major problems deserve to be stressed.
One is the mechanism of the evolution of the various diseases related
to alcohol. In the liver, the pathogenesis of the steatosis and as
sociated metabolic disorders is well understood. They are due to the
metabolism of ethanol, which is a biologic phenomenon not only in
the mammalian liver, but indeed in yeast and other microorganisms;
the latter accounts for the alcohol in beverages. Far less do we about
alcohol-induced cell injury, for instance of hepatocytes (the hepa
titis), where hypotheses still prevail. By contrast, knowledge of the
mechanisms of the hepatic fibroplasia and cirrhosis has recently far
advanced. The understanding of these underlying processes is the
basis of the progress in the management of diseases when withdrawal
of alcohol either does not succeed or, in the rare instances where
it does, they are no longer reversible. Then, modulation of the
disturbed multiple pathways endowed with many feedback loops
offers a more promising approach than the application of a single
drug supposed to stop one particular event, for instance the forma
tion of collagen in fibrosis.
From the thorough review of clinical, experimental, biochemical,
immunologic, and pathologic information in the various diseases,
the answers to the various questions raised should emerge. Thus
the hope is expressed that this comprehensive and up-to-date review
of a major field in gastroenterology will inform as well as stimulate
a wide range of persons who require this knowledge in their pro
fessional activities.
Hans Popper, M.D., Ph.D.
New York
Contents
1 Epidemiology of Alcohol Use and Its Gastrointestinal
Complications
(W. K. Lelbach) .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Ethanol Metabolism and Pathophysiology of Alcoholic Liver
Diseases
(C.S.Lieber) ................................. 19
3 Gamma-Glutamyltransferase and Other Markers for
Alcoholism
(R. Teschke) ................................... 48
4 Ethanol and Lipid Metabolism
(E. Baraona) ................•.................. 65
5 Alcohol Effects on Albumin Synthesis
(M. A. Rothschild, M. Oratz, and S. S. Schreiber) 96
6 Metabolism and Toxicity of Acetaldehyde
(M. Salaspuro and K. Lindros) ...................... 106
7 Ethanol and Fibrogenesis in the Liver
(E. G. Hahn and D. Schuppan) ..................... 124
8 Ethanol, Mallory Bodies, and the Microtubular System
(H. Denk) ..................................... 154
9 Interaction of Ethanol with Drugs and Xenobiotics
(C. Sato, Y. Hasumura, and J. Takeuchi) .............. 172
10 Cytochrome P-450: Its Involvement in the Microsomal
Ethanol Oxidation and Quantitative and Qualitative
Changes After Chronic Alcohol Consumption
(K. Ohnishi and F. Nomura) ....................... 185
x Contents
11 Ethanol and Carcinogenesis
(H.K. Seitz) ................................... 196
12 Ethanol and Biological Membranes: Experimental Studies
and Theoretical Considerations
(T.F. Taraschi and E. Rubin) ...................... 213
13 Alcohol and Porphyrin Metabolism
(M.O.Doss) .................................. 232
14 Ethanol and Hepatic Cell Regeneration
(J.-G. Joly and L. Duguay) ........................ 253
15 Ethanol and the Immune System
(F. Paronetto) .................................. 269
16 Pathology of Alcoholic Liver Disease with Special Emphasis
on Alcoholic Hepatitis
(H. Ishii, I. Okazaki, and M. Tsuchiya) ............... 282
17 Clinical and Therapeutic Aspects of Alcoholic Liver Disease
(c. L. Mendenhall and the VA Cooperative Study
on Alcoholic Hepatitis) ........................... 304
18 Ethanol and the Endocrine System
(D. H. Van Thiel and J. S. Gavaler) 324
19 Effect of Ethanol on Intestinal Morphology, Metabolism,
and Function
(E. Mezey) .................................... 342
20 Esophageal and Gastric Lesions in the Alcoholic
(M. Wienbeck and W. Berges) ...................... 361
21 Acute and Chronic Actions of Alcohol on Pancreatic
Exocrine Secretion in Humans and Animals
(M. V. Singer and H. Goebell) ...................... 376
22 Subject Index .................................. 415
List of Contributors*
Baraona, E. 651 Okazaki, I. 282
Berges, W. 361 Ohnishi, K. 185
Denk, H. 154 Oratz, M. 96
Doss, M. O. 232 Paronetto, F. 269
Duguay, L. 253 Rothschild, M. A. 96
Gavaler, J. S. 324 Rubin, E. 213
Goebell, H. 376 Salaspuro, M. 106
Hahn, E. G. 124 Sato, C. 172
Hasumura, Y. 172 Schreiber, S. S. 96
Ishii, H. 282 Schuppan, D. 124
Joly, J.-G. 253 Seitz, H. K. 196
Lelbach, W. K. 1 Singer, M. V. 376
Lieber, C. S. 19 Taraschi, T. F. 213
Lindros, K. 106 Takeuchi, J. 172
Mendenhall, C. L. 304 Teschke, R. 48
Mezey, E. 342 Tsuchiya, M. 282
Nomura, F. 185 Thiel, D. H. Van 324
Wienbeck, M. 361
* The address of the principal author is given on the first page of each
contribution
1 Page, on which contribution commences
1 Epidemiology of Alcohol Use
and Its Gastrointestinal Complications
W. K. Lelbach
Medizinische Universitiits-Klinik Venusberg,
Sigmund-Freud-Strasse 25, 5300 Bonn 1, Federal Republic of Germany
Trends in Alcohol Consumption
In most European countries aggregate alcohol consumption was quite high during
the latter half of the nineteenth century (Sulkunen 1976), but except in France and
Italy consumption began to decrease after the turn of the century. It reached a
comparatively low level in the years shortly before the Second World War, during
which a further drop occurred. Since the end of World War II, however, alcohol
consumption has been increasing at an alarming rate in nearly all parts of the world,
irrespective of the enormous variation in acceptable drinking habits which initially
prevailed both within and between countries. As a consequence, the prevalence of
alcohol-related disorders and medical complications has almost reached epidemic
proportions. At present, alcohol problems rank among the world's major public
health concerns (World Health Organization 1980) .
. A comparison of the annual average alcohol consumption per capita of total
population in 26 countries throughout Europe and the Anglo-American world
between 1950 and 1981 (Table 1) reveals that there was an overall increase of more
than 100% during this period. However, the increase was particularly high in most of
those countries with a low initial level (less than SHters absolute alcohol per capita).
A stabilization of per capita alcohol consumption (or even a decrease, as in Italy,
Spain, and Austria) was observed during the first half (West Germany, Switzerland,
Belgium, Netherlands, Finland, Ireland) or the second half of the 1970s
(Czechoslovakia, Poland, Luxembourg, Australia), whereas in France, which had
the worlds' highest per capita intake of alcohol, consumption began to decline
gradually much earlier after an unprecedented peak level had been reached in 1955
(Table 2). Larger fluctuations occurred in Portugal during this 30-year period, where
consumption had always ranged above 10 liters per capita. Consumption continued
to increase up to 1981 in the United States, Canada, New Zealand, Japan, Hungary,
Rumania, and Denmark. It seems that drinking habits and patterns are becoming
more uniform throughout the developed countries and that, in general, alcohol
consumption tends to converge on an annual rate of between 10 and 15 liters absolute
alcohol per capita of total population. It could be speculated that this range of
consumption constitutes a kind of saturation level beyond which the requirements of
an increasingly complex modern industrial world could no longer be met. In
low-consumption countries the proportion of abstainers tends to be higher and
A1oohol Related Diseases in Gastroenterology
Edited by H. K. Seitz and B. Kommerell
© Springer-Verlag Berlin Heidelberg 1985