Screening and management of patients with alcohol misuse in the field of liver and gut diseases (notice n° 498909)
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| 000 -LEADER | |
|---|---|
| fixed length control field | 03985cam a2200169 4500500 |
| 005 - DATE AND TIME OF LATEST TRANSACTION | |
| control field | 20250121081750.0 |
| 041 ## - LANGUAGE CODE | |
| Language code of text/sound track or separate title | fre |
| 042 ## - AUTHENTICATION CODE | |
| Authentication code | dc |
| 100 10 - MAIN ENTRY--PERSONAL NAME | |
| Personal name | Barrault, Camille |
| Relator term | author |
| 245 00 - TITLE STATEMENT | |
| Title | Screening and management of patients with alcohol misuse in the field of liver and gut diseases |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. | |
| Date of publication, distribution, etc. | 2023.<br/> |
| 500 ## - GENERAL NOTE | |
| General note | 91 |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | Asking alcohol-related liver or pancreatic disease patients questions is important, as the presentation of these diseases is not specific. Declared alcohol consumption (DAC), expressed in grams per day or per week, is used to assess the health risk, with a DAC of less than 100 g/week being considered “very low risk.” In addictology, alcohol misuse corresponds to dangerous excessive consumption, and alcohol use disorder (AUD) to “harmful” consumption or “dependence,” i.e., a loss of control over consumption. The discovery of a somatic complication therefore leads to the diagnosis of AUD and any dependence must be investigated. In contrast, the AUDIT-C test is useful for systematic screening. In cases of pancreatitis or cirrhosis, abstinence is the best option in terms of prognosis. In the event of hospitalization, oral benzodiazepines—combined with proper hydration—are the only drugs to be used for the prevention and treatment of withdrawal syndrome. Their prescription is based on the patient’s history and the Cushman score, which assesses the severity of the withdrawal syndrome. Hepatic function impairment is not a contraindication to their use in withdrawal syndrome. A protocol should be put in place in each unit. Venous vitamin B therapy in malnourished patients can prevent certain serious central neurological complications. However, some patients cannot immediately project themselves into abstinence, and the addiction specialist will have to reconcile the doctor’s objective with that of the patient. Successfully reducing consumption can be a first step toward abstinence. The treatment plan must therefore be personalized and discussed with the liver specialist, taking into account the patient’s medical, social, professional, and psychiatric situation. Some patients will be treated on an outpatient basis, while others will require full or daily hospitalization in an addictology rehabilitation unit. Anti-abuse drug treatment—also called medication for alcohol use disorder (MAUD)—can help patients at all stages of liver disease, by slowing fibrotic progression, cirrhosis decompensation, and mortality. Two types of molecules are available. Disulfiram has a pure antabuse action, and is used as a second-line treatment to maintain abstinence, but is not recommended in cases of cirrhosis due to its potential serious adverse effects. The other drugs act on the brain’s reward system, reducing the craving for alcohol. Two molecules prescribed three times a day and eliminated by the kidneys can be used at all stages of cirrhosis, with monitoring of kidney function if used alongside diuretics. Acamprosate—prescribed to maintain abstinence—is a glutamate modulator prescribed at a fixed dose. Baclofen—prescribed to reduce alcohol consumption—is a GABAergic agonist whose dosage varies from 30 to 300 mg/d. Two molecules prescribed as a fixed dose taken once a day are eliminated by the liver and are strictly contraindicated if opioid treatment is also being received. Naltrexone is an opioid receptor antagonist prescribed for abstinence maintenance. Nalmefene is an agonist-antagonist prescribed to reduce drug consumption. In all cases, these drugs, which can be prescribed by any doctor, should be combined with psychosocial intervention as part of the overall, often long-term, management of AUD. |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Rosa, Isabelle |
| Relator term | author |
| 786 0# - DATA SOURCE ENTRY | |
| Note | Hépato-Gastro & Oncologie Digestive | 30 | 8 | 2023-10-05 | p. 839-848 | 2115-3310 |
| 856 41 - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href="https://shs.cairn.info/journal-hepato-gastro-oncologie-digestive-2023-8-page-839?lang=en&redirect-ssocas=7080">https://shs.cairn.info/journal-hepato-gastro-oncologie-digestive-2023-8-page-839?lang=en&redirect-ssocas=7080</a> |
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