The effects of alcohol on gastrointestinal tract, liver and pancreas: evidence-based suggestions for clinical management

A. Federico, G. Cotticelli, D. Festi, R. Schiumerini, G. Addolorato, A. Ferrulli, M. Merli, C. Lucidi, S. Milani, C. Panella, M. Domenico, I. Vantini, L. Benini, E. Ubaldi, M. Romano, C. Loguercio

Department of Clinical and Experimental Medicine-Gastroenterology, Second University of Naples, Naples, Italy. alessandro.federico@unina2.it

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• Pharmacology

Alcohol has a direct impact on the digestive system due to its contact with mucosal lining and interference with digestive functions. Various diseases of the gastrointestinal tract, including tumors, may be related to an excess of alcohol intake and the relationship between alcohol abuse and hepatic and pancreatic damage is well established. According to WHO, alcohol and alcohol-related diseases represent a major health problem and will probably continue to do so in the foreseeable future.

In this review, we summarize the present knowledge on clinically relevant alcohol-related problems in order to provide practicing physicians with evidence-based general suggestions which might help in the management of alcohol-related gastrointestinal disorders.

A thorough clinical history together with a number of questionnaires are essential for detecting alcohol dependence or abuse. Biochemical tests (nonspecific and specific) have been considered to be less sensitive than questionnaires in screening for alcohol abuse, but they may be useful in identifying relapses. Protracted behavior modification, cognitive behavioral therapy, psychological counseling, and mutual support groups have been considered the most effective long-term treatments. Several drugs have been developed that are able to interfere with the neurotransmitters involved in craving mechanisms, and we summarize the evidence of their efficacy to increase abstinence and to prevent relapse.

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