Consults for Alcohol-Related Gastrointestinal, Liver Diseases Increase During COVID-19 Pandemic

New research presented during the Digestive Disease Week conference has found that in-patient consults for alcohol-related gastrointestinal (GI) and liver diseases have increased during the COVID-19 pandemic, remaining high even as rates of COVID-19 infections decline.

Investigators conducted a hospital system-wide audit of all in-patient GI consults performed during the lockdown and re-opening phases in Rhode Island during the COVID-19 pandemic. They compared the data to the same timeframe in 2019 to identify the degree of changes in disease burden for alcohol-related GI and liver conditions.

According to a press release, the National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as consuming more than 4 drinks on any day or more than 14 drinks per week for men; and consuming more than 3 drinks per day or 7 drinks per week for women.

In addition to finding that in-patient consults for these diseases increased, the researchers reported that the proportion of patients requiring in-patient endoscopic interventions for their alcohol-related GI and liver conditions increased.

“When we went into lockdown, many people experienced significant negative impacts, such as social isolation, job loss, and an increase in anxiety and depression,” said lead researcher Waihong Chung, MD, PhD, in the press release. “These experiences may have led people to increase their alcohol consumption, which could explain why we are seeing a surge in the volume of consultations for alcohol-related diseases.”

Although the total number of GI consults decreased by 27% during lockdown due to restricted hospital visits, the proportion of consults for alcohol-related GI and liver conditions increased by 59.6%, including alcohol-related forms of hepatitis, cirrhosis, pancreatitis, and gastritis. In comparison, they found no significant changes in the proportions of consults for non-alcohol-related liver diseases; biliary obstruction or injury; inflammatory bowel diseases; or gastrointestinal bleeding.

“In further analysis, we noted that during the lockdown phase, the majority of admission for alcohol-related GI and liver diseases clustered around weeks 5, 6, and 7 of lockdown,” Chung said in the press release. “This timeframe mirrors the length of time it takes for symptoms to appear for these diseases, suggesting the start of the pandemic may have had an impact on patients’ alcohol consumption.”

The total volume of all consults was restored to full pre-pandemic levels during the reopening phase, according to the study. The proportion of consults for alcohol-related GI and liver diseases remained elevated by 78.7%. Furthermore, the number of patients presenting with alcoholic hepatitis more than doubled (127.2%) compared to the number in 2019, and those requiring in-patient endoscopic procedures were considerably higher as well (34% vs. 12.8%).

Because many of these patients with alcohol-related diseases are not admitted immediately to the hospital, the investigators said health problems related to increased alcohol consumption could be even higher in the community. In the press release, the researchers said primary care physicians and gastroenterologists should double down on questioning patients about their alcohol consumption to identify anyone who might need help.

“Validated screening tools, such as the CAGE questionnaire [for alcohol use], only take a minute to administer and offer reasonable sensitivity and specificity for alcohol use disorders,” Chung said in the press release.

REFERENCE

COVID-19 Pandemic Sees Increased Consults for Alcohol-Related GI and Liver Diseases [news release]. Digestive Disease Week; May 14, 2021. https://ddw.org/2021/05/14/covid-19-pandemic-sees-increased-consults-for-alcohol-related-gi-and-liver-diseases/. Accessed May 20, 2021.