Szalay Ferenc
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Belgyógyászati Klinika, Budapest.
Orv Hetil. 2003 Aug 24;144(34):1659-66.
Alcohol induced gastrointestinal diseases are common and significant, and may lead to early death. The annual death caused by alcoholic liver disease and pancreatitis in Hungary is up to 8000. Metabolites, mainly acetaldehyde and free radicals are responsible for the injury. Although the alcohol itself is not carcinogenic, some maligancies are more common among alcoholics.
In this review the hepatic and extrahepatic metabolism of alcohol, the epidemiology, pathomechanism, clinical signs of the alcohol induced organ damages and the treatment options are summarized.
Type IV alcoholdehydrogenase in the stomach has a role in the first pass metabolism. The liver is the main place of the metabolism. If the amount of alcohol exceeds the metabolising capacity, the toxic substances cause lipidperoxidation, membrane and organ injury. Alcohol metabolism is different in the pancreas, the activity of fatty acid ethanol ester synthase activity is more pronounced. In alcoholics the leukoplakia, oropharingeal carcinoma, oesophagitis, Mallory-Weiss syndrome, liver cirrhosis related oesophageal variceal bleeding, chronic gastritis, liver diseases, pancreatitis, bowel motility disorders, malabsorption and colorectal carcinoma are more frequent. The fatty liver remains reversible for a long. Following steatohepatitis, fibrosis, cirrhosis and liver carcinoma may develop. Despite growing knowledge of the role of endotoxins, cytokines, nutritional, immunological and genetic factors, it is still unknown why the given disease will develop in a patient, and there is no parameter for determining the point of irreversibility of the alterations. The possibilities for medical treatment are limited, since some patients do not cooperate properly, and on the other hand, the drugs and measurements can control only a part of the whole process (antioxidants, anti-inflammatory drugs, monoclonal anti-cytokine antibodies), and are appropriate only for the treatment of complications as ascites, portal hypertension, oesophageal varices, portosystemic encephalopathy, malabsortion, infections, vitamin deficiency.
Therefore the prevention and abstinence are very important. The task of the general practitioner and the role of the cooperation among the patient, the physician, the family and the community are very important.
酒精引起的胃肠道疾病常见且严重，可能导致过早死亡。匈牙利每年因酒精性肝病和胰腺炎导致的死亡人数高达8000人。代谢产物，主要是乙醛和自由基，是造成损伤的原因。虽然酒精本身不致癌，但某些恶性肿瘤在酗酒者中更为常见。
在本综述中，总结了酒精的肝脏和肝外代谢、流行病学、发病机制、酒精引起的器官损伤的临床症状以及治疗选择。
胃中的IV型乙醇脱氢酶在首过代谢中起作用。肝脏是主要的代谢场所。如果酒精量超过代谢能力，有毒物质会导致脂质过氧化、膜和器官损伤。酒精在胰腺中的代谢不同，脂肪酸乙醇酯合酶活性更为明显。酗酒者中，白斑、口咽癌、食管炎、马洛里-魏斯综合征、肝硬化相关的食管静脉曲张出血、慢性胃炎、肝病、胰腺炎、肠道动力障碍、吸收不良和结直肠癌更为常见。脂肪肝在很长一段时间内仍可逆转。脂肪性肝炎后，可能会发展为纤维化、肝硬化和肝癌。尽管对内毒素、细胞因子、营养、免疫和遗传因素的作用了解越来越多，但仍不清楚为什么特定疾病会在患者身上发生，也没有确定这些改变不可逆点的参数。药物治疗的可能性有限，因为一些患者合作不佳，另一方面，药物和措施只能控制整个过程的一部分（抗氧化剂、抗炎药、单克隆抗细胞因子抗体），仅适用于治疗腹水、门静脉高压、食管静脉曲张、门体性脑病、吸收不良、感染、维生素缺乏等并发症。
因此，预防和戒酒非常重要。全科医生的任务以及患者、医生、家庭和社区之间合作的作用非常重要。
