Knut Stokkeland

Aim: The aim of our study was to investigate if there were differences in drinking patterns in patients with alcohol dependence (AD), with or without cirrhosis. Methods: We examined three groups in regard to differences in drinking patterns. We collected information from 50 patients with alcoholic cirrhosis (AC), 50 patients with AD, and 40 patients with non-alcoholic cirrhosis (NAC). We used the structured interview Lifetime Drinking History (LDH) to measure the alcohol consumed. Information regarding the total lifetime alcohol intake (LAI), drinking days (DD), drinks per drinking day (DDD), their beverage preferences, and their binge consumption was collected during interviews. Results: Women drank less than men. Women with AC reported 9,198 drinks as binge drinking compared to 25,890 drinks for women with AD without liver cirrhosis (P < 0.05), Women with AC reported 14,009 drinks of alcohol consumed during their lifetime compared to 45,658 drinks consumed by men with AC (P < 0.0001). Women with AD had drunk 5.8 DDD, and men had 8.5 DDD (P < 0.05). Both women and men with AC had significantly fewer DDD compared to men and women with AD without cirrhosis, 4.4 drinks for women (P = 0.046) and 6.2 for men (P = 0.048) with AC. Conclusions: Patients with AC seem to be predisposed to the hepatotoxic effects of alcohol- and the affected women seem to be even more sensitized. Binge drinking, rather than continuous drinking, does not seem to be especially associated with the development of cirrhosis. That women had drunk less alcohol during binge drinking further emphasizes this.

Liver cirrhosis may be complicated by the development of esophageal varices. The treatment of esophageal varices has changed radically during the last 30 years. Our aim was to study whether the prognosis for patients with esophageal varices had improved in Sweden between 1969 and 2002. We linked register data from the Hospital Discharge Register and from the Causes of Death Register at The National Board of Health in Sweden between 1969 and 2002 to identify and follow-up all patients with esophageal varices according to International Classification of Diseases—8, —9, and —10. There were 12,281 patients hospitalized with esophageal varices, and for all patients there was an increase in the 5-year survival in the years between 1969 and 1979 as opposed to the years between 1990 and 2002. Better survival occurred for women compared with men, for younger patients compared with older, and for patients hospitalized in the latest decade compared with the earlier decades. We found a significant decrease in the mortality caused by esophageal varices during the years studied but no decrease attributable to other causes. In conclusion, mortality for patients hospitalized with esophageal varices in Sweden decreased between 1969 and 2002. The decrease is seen for both 1- and 5-year mortality, and this suggests that the use of new treatment strategies both for acute variceal hemorrhage and secondary prophylaxis has had an impact on prognosis. (Hepatology 2006;43:500–505.).