title: Alcoholic liver disease in Nepal: identifying homemade alcohol as a culprit.
abstract: BACKGROUND
  Though the type of alcohol consumed is not thought to be associated with alcoholic liver disease (ALD), some studies have shown a beverage-specific effect. In the present study, we aim to study the effects of locally brewed alcoholic beverages on the development of liver disease.
  
  
  METHODS
  This cross-sectional study was conducted at the internal medicine department of a university hospital in Nepal. All patients classified as having either alcohol abuse or alcohol dependence by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition were evaluated for the presence of ALD.
  
  
  RESULTS
  A total of 1,500 patients were screened, of which, 447 patients had ALD. Chronic liver disease (CLD) was detected in 144 patients (9.6%). Most of the patients consumed homemade locally brewed alcohol. On multivariate analysis, the following variables were found to be significantly associated with CLD: male sex (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.12-2.94; P=0.02): rakshi consumption ≥30 units (OR: 2.53; 95% CI: 1.07-6.01; P=0.04); and tongba consumption (OR: 3.02; 95% CI: 1.22-7.50; P=0.02).
  
  
  CONCLUSIONS
  There was a significant increase in the risk of developing ALD with the consumption of rakshi and tongba after adjusting for total units consumed. The absence of striking differences between our patients with CLD and non-CLD patients with regards to the amount of alcohol consumed demonstrates that, although alcohol consumption is a prerequisite for the development of ALD, other factors like type of alcoholic beverage consumed may be involved.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Bickram
authors.initials: B
authors.lastname: Pradhan
authors.affiliation: Department of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.affiliation: Division of Tropical and Humanitarian Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Shatdal
authors.initials: S
authors.lastname: Chaudhary
authors.affiliation: Department of Community Medicine and School of Public Health, B P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Dharanidhar
authors.initials: D
authors.lastname: Baral
authors.affiliation: Department of Health and Community Medicine. Geneva University Hospital, Geneva, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Gache
authors.affiliation: Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Prahlad
authors.initials: P
authors.lastname: Karki
authors.affiliation: Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
keywords: alcohol use disorders; alcoholic liver disease; locally brewed alcohol