Volume on consults for alcohol-related GI, liver diseases remain elevated throughout COVID-19
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Despite ongoing COVID-19 infection control restrictions, volumes of inpatient consults for alcohol-related gastrointestinal and liver diseases had significantly decreased at the onset of the COVID-19 pandemic, but quickly returned to normal levels, according to an expert presentation during a press conference in advance of Digestive Diseases Week.
“We do believe that the locked down of the pandemic has a direct effect on patients’ alcoholic consumption,” Waihong Chung, MD, PhD, research fellow for the division of gastroenterology at the Warren Alpert Medical School of Brown University, said during his presentation. “I want to stress that many patients with alcoholic related disorders aren’t admitted to hospital right away or at all so we believe that health problems related to increased alcohol use may be even higher in a community. So, we urge primary care physicians or GI doctors and hepatologists to double down on questioning patients about their alcohol use and to identify people who might need help sooner or later.”
Chung — lead researcher of the study — and colleagues performed a hospital system-wide audit of inpatient gastrointestinal consulting performed during the lockdown phase (March 23, 2020 – May 10, 2020; n = 558) and reopening phase of the pandemic (June 1, 2020 – July 19, 2020; n = 713). Then, compared the data with data from 2019 to determine changes in disease burden.
The patients’ discharge summaries were used to derive GI diagnoses.
“We found the total of all GI consults declined by about 27% in the locke down phase due to limitations in the hospital capacity but the proportion of consults for alcohol-related liver disease increased sharply by about 60%. In particular we saw about 53% increase in acute alcoholic hepatitis, which is a very serious condition with high short-term mortality,” Chung said. “In the reopening phase the total volume of GI consults returned to pre-pandemic levels.”
According to researchers, the proportions of consults for non-alcohol–related liver diseases, biliary obstruction/injury, inflammatory bowel diseases, or gastrointestinal bleeding did not significantly change. During the reopening phase, the volume of consults was restored to 101% of that of the same period in 2019.
Results showed the proportion of consults for alcohol-related GI and liver diseases remained elevated by 78.7% (P = .01); however, the proportion of consults for alcoholic hepatitis increased by 127.2% (P < .01). In addition, the proportion of patients with alcohol-related GI and liver diseases who required inpatient endoscopic interventions was significantly higher (34.6% vs. 13.8%; P = .04). However, there was no statistical difference in the average age, Maddrey’s discriminant function, or model for end-stage liver disease score, among patients with alcoholic hepatitis or alcoholic cirrhosis in 2020 vs. those in 2019.
Perspective
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The Scripps group noted that there was a significant increase in alcohol-related liver disease cases that occurred as the pandemic progressed from the late summer to December 2020. They also noted, in addition to alcohol-related liver disease, there were a variety of other alcohol-related comorbidities that increased in volume (ie, neuropsychiatric disorders and alcoholic pancreatitis).
These results arise from what has been observed throughout the U.S. during the pandemic; that is, increased alcohol sales, and it is to be expected that increased alcohol consumption has led to increased cases of alcohol associated disease cases and comorbidities both in the hospital and in outpatient encounters. As we emerge from the pandemic, it will be important to devote resources to ensure those with alcohol associated diseases can be engaged in care and be provided the support they require.
This study was also nicely complemented by Chung’s presentation, which also noted, similar to the increase in alcohol associated liver disease cases, that consults on alcohol-related GI and liver disease — particularly alcoholic hepatitis — increased by over 50% during the lockdown and has remained elevated. This trend is something we will have to monitor as we continue to emerge from shelter, and hopefully recalibrate to a more typical level of alcohol-associated liver disease consults. Time will tell whether this now is going to be the new normal for the contribution of alcohol-associated liver disease as well as other types of liver disease consults we see.
Both these presentations reflect that the pandemic drove an increase in alcohol consumption and this alcohol consumption is now reflected in an increased burden of alcohol-associated liver disease that our gastroenterology and hepatology colleagues are now seeing across the country.
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Chung W. et al. Abstract 436. Presented at: Digestive Disease Week (virtual); May 13, 2020.
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