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Alcohol related disease to 'rise markedly'

The burden of alcohol related gastrointestinal disease, alcoholic liver disease and pancreatitis, will increase markedly over the coming decade or more, according tothe British Society of Gastroenterology. Managing the health consequences of the rising tide of alcohol misuse in the United Kingdom will be one of the key challenges of the future, and much of it will fall to the gastroenterology and Hepatology services in acute hospitals, the Society concludes.

The Society, in a report putting forward a strategy for improving the care of patients with gastrointestinal disorders, says that the care of patients with alcohol-related diseases causes particular difficulties to gastroenterologists. The liver and GI tract are the most common focus for alcohol related damage and in most inner-city hospitals, the management of in-patents with alcoholic liver disease and its complications is the largest single workload that GI physicians face. Furthermore, when around 20% of unselected emergency admissions are alcohol-related, many of them gravitate to GI physicians under triage systems even when there are no specific liver or GI problems, for instance, patients suffering from alcohol withdrawal or the social consequences of alcohol dependence.

The Society says that it is important to anticipate that the burden from alcohol is going to increase markedly over the coming decade or more.

“As a nation, we are drinking more than for 90 years and there is a lag time between consumption and cirrhosis. Already, we have seen a 350% increase in cirrhosis between 1970 and 1998, and this figure is 900% for those under 45 years of age. Patients with alcoholic cirrhosis and alcoholic pancreatitis and related complications are heavy users of expensive hospital resources, particularly length of stay, intensive care, blood and interventional procedures, and they are often regarded by other specialties and departments as of lower priority because of the perceived self-afflicted nature of the condition.”

The Society says that GI physicians accept their key role in the management of patients with alcohol-related disease but realise that they cannot take on this load without explicit consideration of the implications. The Society endorses the evidence-based blueprint for managing alcohol related diseases produced in 2001 and reaffirmed at a recent joint Royal College of Physicians/British Society of Gastroenterology conference in early 2005 entitled ‘Alcohol related harm – a growing crisis, time for action!’

The blueprint included recommendations for local care by acute hospitals receiving unselected medical admissions:

  • Screening strategy for early detection of harmful/coincidental hazardous drinkers. Early assessment of dependence severity by appropriately trained staff.
  • Widely available protocols for the pharmacotherapy of detoxification.
  • Readily available “acute response” from liaison or specialised alcohol psychiatry services for the management of patients undergoing “complicated” alcohol withdrawal.
  • Assessment of the need for referral to on-going support services by appropriately trained staff with knowledge of local services.
  • Provision of brief interventions for coincidental hazardous drinkers.
  • Provision of general staff education.
  • Occupational policies for alcohol for all hospital health care workers, for examples with respect to drinking at work.
  • Close liaison with General Practitioners on discharge.

The blueprint also recommended that Health Trusts’ strategy should include the identification of:

1. A senior member of medical staff and a senior member of nursing staff to act as a focus for alcohol strategy and to support more junior members of staff.

2. Senior psychiatric colleagues with an interest in the management of alcohol problems to act as the primary link between the acute hospital trust and local mental health services. This individual may or may not be employed by the acute trust.

3. One or more dedicated alcohol health workers employed by and answerable to the acute Trust. The roles will include:

  • a. Implementation of screening strategies.
  • b. Detoxification of dependent drinkers
  • c. Brief interventions in hazardous drinkers.
  • d.Referral of patients for on-going support/with access/knowledge about locally available non-statutory/ voluntary agencies.
  • e. To provide links with liaison/specialist alcohol psychiatry.
  • f. An education resource and support focus for other health care workers in the Trust.

Care of Patients with
Gastrointestinal Disorders in the
United Kingdom: A Strategy for the
Future. British Society of
Gastroenterology. March 2006