Research presented today at Digestive Disease Week® (DDW) explores new discoveries in liver disease research, with findings about the impact of coffee on autoimmune disease and palliative care for cirrhotic patients.
While coffee consumption recently has been associated with reduced risk of fibrosis, a new study found that even a few more cups of java each month also correlate with lower risk for a particular autoimmune liver disease. Researchers at the Mayo Clinic, Rochester, MN, linked coffee consumption with reduced risk of primary sclerosing cholangitis (PSC), a disease of the bile ducts that causes inflammation and subsequent duct obstruction that ultimately can lead to cirrhosis of the liver, liver failure and biliary cancer.
“While rare, PSC has extremely detrimental effects,” said Craig Lammert, MD, instructor of medicine at Mayo Clinic. “We are always looking for ways to mitigate risk, and our first-time finding points to a novel environmental effect that might also help us to determine the cause of this and other devastating autoimmune diseases.”
Funded by grants from the National Institutes of Health and the American Liver Foundation, the study examined the largest cohort of patients with PSC and primary biliary cirrhosis (PBC) in the U.S. as well as a healthy control group. Data showed that coffee consumption was associated with reduced risk of PSC, but not PBC. PSC patients were much more likely to never consume coffee compared with the control group. The control group also spent nearly 20 percent more of their life regularly drinking coffee.
Study highlights need of terminally ill cirrhotic patients
Other DDW research illuminates the need for better palliative care for terminally ill cirrhotic patients who are rejected for a liver transplant. A retrospective cohort review of patients previously assessed or listed for liver transplant by the University of Alberta in Canada found that only 3 percent of patients in the study died while in hospice, a hallmark of palliative care.
About 83 percent of adults drink coffee in the U.S., the world’s biggest consumer of the beverage, up from 78 percent a year earlier, according to the National Coffee Association’s 2013 survey.
The New York-based group said today in a statement that 63 percent of adults drink coffee every day, compared with 65 percent a year earlier and 58 percent in 2011. The data was compiled from an online survey of 2,840 respondents from mid- January to mid-February.
Among respondents 18 to 24 years old, daily consumption fell to 41 percent from 50 percent. The total for those 25 to 39 years old dropped to 59 percent from 63 percent. The association released the survey results in San Francisco at its annual conference.
About 13 percent of the U.S. population used the single-cup format, up from 4 percent two years earlier.
Among those 60 years and older, daily consumption rose to 76 percent from 71 percent, and the total for 40 to 59 years old climbed to 69 percent from 65 percent.
“In our study, less than 10 percent of patients had even been referred to palliative care,” said Constantine Karvellas, assistant professor of medicine at the University of Alberta. “We need to be better about ensuring quality of life for these patients.”
Epidemiology of Autoimmune Liver Disease
Primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) are chronic liver diseases that likely have an autoimmune basis to their pathogenesis. Although significant strides have been made in the clinical management of these conditions, their pathogenesis remains obscure. Understanding of various epidemiological factors may shed light on predisposing or causative factors for these diseases. Most is known about the epidemiology of PBC, with only minimal information on that of PSC and AIH. In this review, the current data on the epidemiology of PBC, AIH and PSC are summarized and suggestions are made for future work in this important area.
Primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) are chronic liver diseases that likely have an autoimmune basis to their pathogenesis. While these diseases are generally distinguishable based on clinical grounds, occasionally patients will exhibit features suggestive of an overlap syndrome. Unfortunately, the etiology of all three diseases remains obscure. Epidemiology can be a powerful tool by which to gain important insights about diseases based on their associations. Over the last number of years, more sophisticated techniques have been applied to better understand the epidemiology of autoimmune liver disease, however, many questions remain unanswered. In this review, we summarize what is currently known about the epidemiology of PBC, AIH and PSC and make some suggestions for future work in this important area.
Palliative care is specialized medical care for people with serious, often terminal, illnesses. Its goal is to improve patients’ quality of life by concentrating on relief from symptoms, pain and stress.
The patients in Dr. Karvellas’s study had been de-listed or declined for liver transplantation. The most common reason was noncompliance with restrictions on substance use, but other reasons related to cancer and multiple organ dysfunction. Researchers examined patients’ medical trajectory and the symptoms prominent at their end of life and found that more than half had pain and nausea. Others had symptoms of depression, anxiety, breathlessness and anorexia. Eighty percent required repeat hospital admissions and invasive procedures such as paracentesis, in which fluid accumulation is drained from the abdomen.
“Palliative care offers a way to avoid some of these costly procedures and at the same time improve the quality of life for these patients. These data help to start the conversation on how we can make a positive difference in the lives of many patients and families,” Dr. Karvellas said.
Smoking as a risk factor for autoimmune liver disease: what we can learn from primary biliary cirrhosis
Primary biliary cirrhosis (PBC) is a cholestatic liver disease characterised by the immune-mediated destruction of biliary epithelial cells in small intrahepatic bile ducts. The disease is characterised by circulating anti-mitochondrial antibodies (AMA) as well as disease specific anti-nuclear antibodies (ANA), cholestatic liver biochemistry, and characteristic histology. The disease primarily affects middle-aged females, and its incidence is apparently increasing worldwide. Epidemiological studies have indicated several risk factors for the development of PBC, with family history of PBC, recurrent urinary tract infection, and smoking being the most widely cited. Smoking has been implicated as a risk factor in several autoimmune diseases, including the liver, by complex mechanisms involving the endocrine and immunological systems to name a few. Studies of smoking in liver disease have also shown that smoking may progress the disease towards fibrosis and subsequent cirrhosis. This review will examine the literature surrounding smoking as a risk factor for PBC, as well as a potential factor in the progression of fibrosis in PBC patients.
Dr. Lammert will present data from the study “Coffee consumption is associated with reduced risk of primary sclerosing cholangitis but not primary biliary cirrhosis,” abstract 630, on Monday, May 20, at 10 a.m. ET in Room 205A of the Orange County Convention Center.
Dr. Karvellas will present data from the study “Paucity of palliation in cirrhotic patients: a retrospective study and needs assessment,” abstract 796, on Monday, May 20, at 4:30 p.m. ET in Room 202AB of the Orange County Convention Center.
Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 18 to 21, 2013, at the Orange County Convention Center, Orlando, FL. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
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