Gastrointestinal victims of alcohol: the liver and the pancreas
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Alcohol consumption is among the leading causes of death worldwide and is the third among the causes of diseases, the first being smoking, the second hypertension. Harmful use of alcohol is a pattern of psychoactive substance use that is causing damage to health, incorporating the pattern and volume of drinking over time, the drinking context and the quality or contamination of the consumed beverages. Of note, a protective effect was observed in ischemic stroke and diabetes mellitus, which does not compensate the various detrimental effects alcohol poses on physical and mental health. According to the World Health Organisation’s (WHO) report on alcohol consumption from 2018, 43% of the population reports current drinking, which translates as more than 2.3 billion consumers. In general, men are more affected by harmful alcohol consumption than women. In 2016, 53.6% of men consumed alcohol in the last 12 months, whereas only 32.2% of women drank. Interestingly, the prevalence of alcohol use disorders (AUD) is 5 times higher in men (8.6% compared to 1.7% in women), which may be explained by more excessive consumption and the preference for hard drinks. Most alcoholrelated deaths are due to digestive system diseases (21.3%) and they are the second biggest contributors to the alcohol-attributable burden of disease, highlighting the role of gastroenterologists in the fields of prevention and treatment. The most frequent and severe gastroenterological diseases caused by harmful alcohol consumption are cirrhosis, acute-on-chronic liver failure (ACLF), alcohol-induced acute pancreatitis (AP) and tumours. Alcohol consumption also facilitates the development of gastrooesophageal reflux, alcoholic gastritis and gastropathy, peptic ulcer disease, diarrhoea and plays a role in the development of oropharyngeal, oesophageal, gastric, colorectal, pancreatic and liver cancer.