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Alcohol abstinence is essential - even in advanced liver cirrhosis

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(Vienna, 13-12-2022) Complete abstinence from alcohol is considered a cornerstone in the treatment of patients with alcohol-related liver disease. It has not yet been sufficiently studied whether this measure can still improve the prognosis even in advanced stages of liver cirrhosis. Scientists at the Department of Internal Medicine III at MedUni Vienna and AKH Vienna have now provided evidence of the positive effects of alcohol abstinence even at very advanced stages of the disease. The results of their clinical study were recently published in the journal “Clinical Gastroenterology and Hepatology”.

As part of the study, the research team led by Benedikt Hofer and Thomas Reiberger from the Clinical Division of Gastroenterology and Hepatology at the Department of Internal Medicine III at MedUni Vienna and AKH Vienna analysed the clinical course of 320 patients with alcohol-related liver cirrhosis. Not only the influence of alcohol abstinence was investigated, but also the effect of portal hypertension. Portal hypertension refers to increased blood pressure in the veins that transport blood from the gastrointestinal tract to the liver, and is - in addition to ongoing alcohol consumption - largely responsible for the progression of liver disease.

By analysing both factors, the researchers have now gained insights into the effect of alcohol abstinence in advanced liver cirrhosis at different stages of portal hypertension. "Our results clearly show that all patients with alcohol-related liver cirrhosis who maintain sustained abstinence from alcohol not only show a significant lower risk for developing complications of liver cirrhosis, but also live considerably longer - even in the case of pronounced portal hypertension," explains the lead author of the study, Benedikt Hofer.

Evidence for prognostic relevance
Liver cirrhosis is defined by pronounced scarring of the liver, and represents one of the most frequent and most severe complications of excessive alcohol consumption. According to current data of the Federal Ministry of Social Affairs, Health, Care and Consumer Protection (Alcohol Manual - Austria, 2021), 11.7 litres of (pure) alcohol per year or 25.3 grams of alcohol per day (20 grams correspond to 0.5 litres of beer) are consumed per capita in Austria from the age of 15. This makes Austria one of the internationally top-ranked countries in regards of alcohol consumption.

Even though complete abstinence from alcohol is recommended as a basic therapy for patients with alcohol-related liver disease, the prognostic relevance of abstinence in advanced liver cirrhosis has been insufficiently researched to date. "Our new data provide important evidence for the daily counselling of our patients and show that it is never too late to strive for complete abstinence from alcohol," says the head of the study, Thomas Reiberger. However, the study also showed that even patients with sustained abstinence from alcohol are at risk of developing complications - especially if the extent of portal hypertension remains very pronounced. Therefore, affected patients with cirrhosis need regular medical check-ups.

Personalised therapy options
As also shown in the study, the measurement of portal hypertension provides important prognostic information in patients with alcohol-related liver cirrhosis, regardless of alcohol consumption. The minimally invasive examination of the hepatic vein pressure gradient is considered the gold standard for evaluating the extent of portal hypertension. The technique has been continuously refined over the past few years in MedUni Vienna's Hepatic Hemodynamic Laboratory. The refined methodology creates optimised and personalised treatment options for patients with liver cirrhosis.

Publication: Clinical Gastroenterology and Hepatology
Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis;
Benedikt Silvester Hofer, Benedikt Simbrunner, Lukas Hartl, Mathias Jachs, David Josef Maria Bauer, Lorenz Balcar, Rafael Paternostro, Philipp Schwabl, Georg Semmler, Bernhard Scheiner, Albert Friedrich Stättermayer, Michael Trauner, Mattias Mandorfer, Thomas Reiberger;

doi.org/10.1016/j.cgh.2022.11.033