title: Liver Disease and Hepatocellular Carcinoma in Alcoholics: The Role of Anticraving Therapy.
abstract: Alcohol is the main risk factor for death and disability. The treatment of alcohol dependence (AD) is a complex activity as the variables are numerous; however, those which must necessarily be taken into account are the type of AD, the internal comorbidities and the presence of any psychiatric comorbidity. Liver problems are one of the most common causes of alcohol-related liver damage. 45% of deaths from cirrhosis are alcohol-related. Thus, the treatment of AD must often deal with a more or less severe liver disease, which influences the choice of anticraving drug. As chronic liver disease is often present, and as in a substantial proportion of cases, because there is a correlation with viral infections or with hepatocellular carcinoma (HCC), it is clear that hepatologists should make use of nonhepatotoxic molecules. In cases of mild liver disease, all available drugs might be used, but we recommend caution because the liver is usually fragile due to the harmful abuse of alcohol. In the advanced liver disease, the choice of treatment is reduced. A psychosocial approach such as attending support groups could be the first choice. In cases of compensated cirrhosis with or without HCC, or in cases of HCC without cirrhosis, metadoxine, acamprosate and baclofen can be used. In decompensated forms the only drug tested to date has been baclofen. In alcohol-related liver disease a professional team with hepato-alcohologists is also necessary, especially for liver transplantation programs.
authors.affiliation: Centro Alcologico Regionale - Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy. paolo.borro@hsanmartino.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borro
authors.forename: Silvia
authors.initials: S
authors.lastname: Leone
authors.forename: Gianni
authors.initials: G
authors.lastname: Testino
mesh_terms: D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000627:therapeutic use; D057229:Alcoholics; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D001418:Baclofen / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000188:drug therapy* / Q000523:psychology; D004338:Drug Combinations; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000188:drug therapy* / Q000523:psychology; D008113:Liver Neoplasms / Q000139:chemically induced / Q000188:drug therapy* / Q000523:psychology; D011736:Pyridoxine / Q000627:therapeutic use; D011761:Pyrrolidonecarboxylic Acid / Q000627:therapeutic use; D012307:Risk Factors; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D004338:Drug Combinations; D013654:Taurine; C037845:metadoxine; D001418:Baclofen; D011736:Pyridoxine; D000077443:Acamprosate; D011761:Pyrrolidonecarboxylic Acid