From the Guidelines
Chronic alcohol abuse can lead to severe and life-threatening complications, including liver cirrhosis, hepatocellular carcinoma, and increased risk of infections, with a significant impact on morbidity, mortality, and quality of life. The liver is particularly vulnerable to the effects of chronic alcohol consumption, with conditions ranging from fatty liver disease to alcoholic hepatitis and cirrhosis, which can progress to liver failure 1. Neurological complications include peripheral neuropathy, Wernicke-Korsakoff syndrome (caused by thiamine deficiency), cognitive impairment, and dementia. Cardiovascular effects include cardiomyopathy, hypertension, and increased risk of stroke. Gastrointestinal complications extend beyond the liver to include chronic pancreatitis, gastritis, and increased risk of various cancers (mouth, throat, esophagus, liver, and colon) 1.
Key Complications
- Liver cirrhosis: a significant risk factor for hepatocellular carcinoma, with an annual incidence of 2.6% in patients with Child-Pugh A and B cirrhosis 1
- Increased risk of infections: bacterial infections and sepsis are major complications of cirrhosis, leading to an approximately fourfold increase in mortality 1
- Malnutrition: poor nutritional status and sarcopenia may affect up to 50% of patients with alcoholic liver disease, resulting from increased catabolism, insufficient intake of calories, micronutrients, and vitamins 1
- Cardiovascular complications: cardiomyopathy, hypertension, and increased risk of stroke
- Gastrointestinal complications: chronic pancreatitis, gastritis, and increased risk of various cancers
Management and Treatment
Treatment typically requires complete abstinence from alcohol, nutritional support (particularly B vitamins), and addressing specific organ damage. Medications like acamprosate, naltrexone, or disulfiram may help maintain sobriety, while psychological support through counseling or support groups is essential for long-term recovery. Abstinence from alcohol is crucial in reducing the risk of complications and improving survival rates, with a 5-year survival rate approaching 90% in compensated alcoholic liver cirrhosis with abstinence 1.
From the Research
Chronic Complications of Alcohol Abuse
The chronic complications of alcohol abuse are numerous and can affect various organ systems. Some of the complications include:
- Alcohol withdrawal syndrome (AWS), which can be life-threatening in its most severe form 2, 3, 4
- Alcohol-associated liver disease, which comprises a clinical-histologic spectrum of presentations, from steatosis, steatohepatitis, to different degrees of fibrosis, including cirrhosis and severe necroinflammatory disease 5
- Increased risk of certain cancers, other tumors, neuropsychiatric conditions, and numerous cardiovascular and digestive diseases 6
- Beneficial and detrimental impacts on diabetes, ischemic stroke, and ischemic heart disease, depending on the overall volume of alcohol consumed and consumption patterns 6
Organ Systems Affected
The chronic complications of alcohol abuse can affect nearly every organ system, including:
- Liver: alcohol-associated liver disease, cirrhosis, and severe necroinflammatory disease 5
- Nervous system: alcohol withdrawal syndrome, convulsions, and delirium tremens 2, 3, 4
- Cardiovascular system: increased risk of ischemic heart disease and ischemic stroke 6
- Digestive system: increased risk of digestive diseases 6
Treatment and Management
Treatment and management of chronic complications of alcohol abuse include:
- Pharmacologic treatment of alcohol use disorder, such as benzodiazepines for AWS 2, 3, 4
- Abstinence and nutritional support for alcohol-associated liver disease 5
- Corticosteroids for alcohol-associated hepatitis 5
- Novel therapies, such as metadoxine, interleukin-22 analogs, and interleukin-1-beta antagonists, for alcohol-associated hepatitis 5