BACKGROUND: Concern among Scots gastroenterologists about alcohol related illness prompted this inpatient prevalence study during the winter of 2000-01. AIMS: To study gastrenterology inpatient workload due to alcohol-related illness, to determine how much was specialty specific, and if there were regional variations. METHODS: 40 Consultant gastrenterologists throughout Scotland collected data on the prevalence of alcohol related conditions among inpatients under their care on each of three specified days during the winter of 2000/2001. All inpatients under the care of participating consultants on the designated study days were included in the study. Overall return rate was 65%. Patients were categorised as follows; (a) general medical inpatients admitted for reasons other than alcohol related illness (b) general medical inpatients with no gastrointestinal or liver disease, but whose admission to hospital was primarily related to alcohol misuse, (c) gastrointestinal (including liver) inpatients admitted for reasons unrelated to alcohol intake, and with no alcohol related disease, and (d) gastrointestinal inpatients whose admission to hospital resulted from alcohol related disease. Additionally the numbers of patients with (e) decompensated liver disease of all causes, (f) decompensated alcoholic liver disease, and (g) the numbers "blocking" acute beds after initial hospitalisation with an alcohol related illness were collected. RESULTS: Overall, 829 general medical and 538 gastroenterology inpatients were entered in the study; total 1367 (705 male, 662 female). Of these, 25% (337/1367) were admitted because of alcohol related illness: 15% (201/1367) had decompensated alcoholic liver disease. Of 538 gastroenterology inpatients, 238 (44%) had problems related to alcohol and 201 of these (37% of all gastoenterology inpatients) had decompensated alcoholic liver disease. Of 246 inpatients with decompensated liver disease, 82% (201) had alcoholic liver disease. Alcohol related illness was significantly more prevalent among male inpatients in the West of Scotland. 10% of specialist gastroentelogy beds were occupied by patients whose discharge was delayed because of alcohol related problems. CONCLUSION: Most Scottish gastroenterlogists contribute to general medical receiving but their specialist inpatient workload is dominated by treatment of patients with alcohol related disease. (44% in gastroenterology v 12% in general medicine). Inpatients with decompensated alcoholic liver disease form 37% of gastroenterology workload. Alcohol related disease contributes to delayed discharge in acute medical units, especially in gastroenterology wards. There are regional differences in prevalence of alcohol related disease, which is greatest in male inpatients in the West of Scotland. Here, alcoholic liver disease accounts for nearly a decompensated liver disease. The findings point to a need to review the current patterns of acute service provision for alcohol related illnesses, so as to assess and improve both the linical effectiveness and cost effectiveness of care, and to ensure that alternatives to acute hospital admission are available when appropriate. This need should not be neglected while efforts are simultaneously being made to improve the early detection of alcohol abuse and prevent irreversible alcohol related disease.