Bethesda, MD
Inpatient visits for alcohol -related gastrointestinal (GI) and liver illnesses have increased since the start of the COVID-19 pandemic and have remained elevated, according to research selected for presentation at Digestive Disease Week® (DDW) 2021.
The proportion of patients requiring in-hospital endoscopic interventions for their alcohol-related gastrointestinal and liver diseases has also increased, highlighting an apparent trend of worsening disease severity.
The proportion of consultations remained high even after reopening
"When we went into lockdown, many people experienced significant negative impacts, such as social isolation, job loss, and increased anxiety and depression," said Waihong Chung, MD, PhD, principal investigator of the study and research associate at the Division . of Gastroenterology at the Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. "These experiences may have led people to increase their alcohol consumption, which could explain why we are seeing an increase in the volume of consultations for alcohol-related illnesses."
Researchers conducted a hospital system-wide audit of all inpatient gastrointestinal visits performed during the closure and reopening phases in Rhode Island during the COVID-19 pandemic. The data was compared to the same time period in 2019 to determine the degree of changes in disease burden for alcohol-related gastrointestinal and liver conditions.
While the total number of gastrointestinal consultations decreased by 27 percent during lockdown, due to restrictions on hospital visits, the proportion of consultations for alcohol-related gastrointestinal and liver diseases increased sharply by 59.6 percent, including alcohol-related forms of hepatitis, cirrhosis, pancreatitis and gastritis, the researchers found.
In comparison, there were no significant changes in the proportions of consultations for non-alcohol-related liver diseases, biliary obstruction/injury, inflammatory bowel diseases or gastrointestinal bleeding.
"In further analysis, we noticed that during the lockdown phase, most admissions for alcohol-related gastrointestinal and liver diseases clustered around five weeks, six and seven weeks of lockdown," Dr Chung said. "This time period reflects the time it takes for symptoms of these diseases to appear, suggesting that the onset of the pandemic may have had an impact on patients’ alcohol consumption."
In the reopening phase , the total volume of all gastrointestinal consultations was restored to full pre-pandemic levels and the proportion of consultations for alcohol-related gastrointestinal and liver diseases remained very high at 78.7 percent. Additionally, patients presenting with alcoholic hepatitis more than doubled (127.2 percent) compared to 2019 and those requiring in-hospital endoscopic procedures were considerably higher (34 percent vs. 12.8 percent).
Because many people who have alcohol-related illnesses are not admitted to a hospital right away, researchers believe that health problems related to increased alcohol consumption could be even greater in the community. They encourage primary care physicians and gastroenterologists to double down on questioning patients about their alcohol use to identify anyone who may need help sooner rather than later.
"Validated screening tools, such as the CAGE [alcohol use] questionnaire, only take one minute to administer and offer reasonable sensitivity and specificity for alcohol use disorders," Dr. Chung suggested.
The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as consuming more than four drinks in a day or more than 14 drinks per week for men; and consuming more than three drinks on any day or more than seven drinks per week for women.
"Alcohol-related gastrointestinal or liver diseases can cause sudden weight gain, yellowing of the skin, confusion, fatigue, decreased appetite, black stools, and/or severe abdominal pain," Dr. Chung said. "I encourage anyone experiencing these symptoms, as well as anyone who is concerned about their own drinking, to see a doctor as soon as possible."
