Identifying, treating alcohol-associated liver disease in women requires change in mindset
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PHILADELPHIA — The rate of alcohol-associated liver disease among women is the rise and physicians must keep it in mind when discussing medical history with their female patients, according to a review presented here.
The findings were presented as part of the Postgraduate Course at the ACG Annual Meeting.
“During the period of the COVID pandemic ... there was a prominent increase in alcohol-related deaths,” Vijay H. Shah, MD, FACG, Mr. and Mrs. Ronald F. Kinney Executive Dean of Research and professor at the Mayo Clinic, said during his presentation. “Unfortunately, despite the decline in the pandemic impact, the numbers of alcohol-related deaths continue to maintain this very high level.”
In an analysis of alcohol-related liver disease since that time, Shah said the risk among women is increasing.
According to Shah, notable hurdles in the recognition of and access to treatment for alcohol use disorder among women include:
- Transportation difficulties and inadequate insurance
- The misconception that “women do not drink more than men”
- Lack of alcohol misuse treatment research for women
- Stigma in receiving care, especially in underrepresented ethnic groups
- Men with alcoholic liver disease more likely to be listed for and receive a transplant
“This highlights the disparities and access [to] treatment for women, largely due to stigma and receiving care as well as doctors asking women less about drinking, [being] less likely to give advice on alcohol use and the stigma of actually receiving alcohol use therapy for women,” Shah said.
He suggested future patient-centered outcome research in alcohol use disorder should include more women, while comparative effectiveness research should analyze the harm-to-benefit comparison of available evidence. Lastly, community-centered assessments should include surveys of women in the community.
Possibly compounding this gender-based difference in alcohol use disorder is that women are more likely to undergo bariatric surgery, which is being connected to alcohol-associated liver disease postoperatively.
“This is emerging to be quite important in relevance to alcohol liver disease and is also important for female sex, which is now emerging as increasing incidence of alcohol liver disease than what we used to see in the past,” Shah said.
Shah reported that while 12% of individuals reported binge drinking before bariatric surgery, 23% reported it after surgery. In the same survey, 28% of participants endorsed problems with alcohol control after bariatric surgery compared with only 5% before surgery.
Binge drinking at the time of bariatric surgery was associated with liver disease, suicide and increased long-term mortality, he noted.
Though the mechanisms for this change are not known, researchers theorize it could be due to neurohumoral consequences of gastric secretion, the concept of addiction transfer from food to alcohol and changes in alcohol metabolism, Shah added.
“We don’t understand everything exactly, but there is a metabolism of alcohol that happens in your stomach and when you bypass that, alcohol will go straight into your blood,” Shah said during a Q&A. “That maybe accounting, in part, why people are getting more liver toxicity after drinking after bariatric surgery.”
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Shah VH. Alcohol-associated liver disease: Recommendations from the guidelines. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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