Pandemic Drinking Took Swift Toll on the Gut, Liver

Inpatient consults for alcohol-related GI and liver diseases surged after the beginning of the COVID-19 pandemic in 2020 and remained elevated, researchers found.

The proportion of inpatients requiring endoscopic interventions for their alcohol-related GI and liver diseases also increased, suggesting a worsening trend in severity, according to data presented at a pre-meeting press conference for the virtual Digestive Disease Week (DDW) conference.

In addition to effects on physical health due to delayed or limited healthcare access mandated by infection-control restrictions, many people experienced negative psychosocial impacts such as isolation, anxiety, depression, job loss, and economic insecurity, noted Waihong Chung, MD, PhD, of the Warren Alpert Medical School at Brown University in Providence, Rhode Island. “These are risk factors for the development of other health problems such as addiction.”

After noticing a substantial increase in inpatient consults for alcohol-related problems last year, Chung’s group conducted a system-wide hospital audit of all inpatient GI consults performed during the lockdown and re-opening phases in the largest healthcare system in Rhode Island. The researchers then compared these findings with data from the same period in 2019 to determine changes in the disease burden of alcohol-related GI and liver conditions.

During the pandemic lockdown phase from March 23 to May 23, 2020, there were 558 consults; during the reopening phase from June 1 to July 19, consults rose to 713. Diagnoses were ascertained from the patients’ discharge summaries and verified by an independent review of associated GI consult notes.

While the total number of all GI consults declined by 27% during lockdown following restrictions on hospital capacity, the proportion for alcohol-related GI and liver diseases increased sharply by 59.6% (P=0.03).

Of note, alcoholic hepatitis increased 53% over the study period. This serious condition with high short-term mortality predominated among inpatient consults, accounting for 75% to 80% of them. Other alcohol-linked conditions ranged from cirrhosis and pancreatitis to esophagitis and gastritis.

Furthermore, clinical parameters were worse both in terms of endoscopic intervention rates and outcomes by blood count and liver function tests.

Notably, as the pandemic wore on, the inpatient cohort became younger. During the lockdown, the median age was 56 and 70% were male. “During reopening, the proportion of males was the same but patients were younger with a median age of 51 versus 56,” Chung said.

In comparison, there were no significant changes compared with 2019 in the proportions of consults for non-alcohol-related liver diseases, biliary obstruction or injury, inflammatory bowel diseases, or GI bleeding.

During the lockdown phase, the majority of admissions for alcohol-related GI and liver diseases clustered around weeks 5, 6, and 7, a period reflecting the length of time it takes for symptoms to appear from these diseases, which suggested an immediate impact from the start of the pandemic. “We do believe the lockdown had a direct effect on these patients’ alcohol consumption, and we believe the health problems related to alcohol consumption may be even higher in the community,” Chung said.

During the reopening phase, the total volume of all GI consults was restored to 101% of pre-pandemic levels, but the proportion of consults for alcohol-related conditions remained highly elevated by 78.7% compared with 2019 (P=0.01). Furthermore, the proportion of patients presenting with acute alcoholic hepatitis rose by 127.2% compared with 2019 (P≤0.01). Those requiring inpatient endoscopic interventions rose to 34% versus 12.8% (P=0.04).

The bottom line, Chung said, is that healthcare providers should proactively screen for and aggressively address alcohol use disorder. “Primary care and GI doctors and hepatologists need to double down and ask patients about their alcohol use and identify people who need help sooner rather than later,” he said.

He recommended doctors use a neutral mode of questioning in the context of routine care, asking patients whether they drink alcohol, how much they typically consume, and how much they consumed in the past week. Validated alcohol abuse screening tools, such as the CAGE questionnaire, only take a minute to administer and offer reasonable sensitivity and specificity for alcohol use disorders, Chung said.