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Alcohol putting pressure on GI services
[Posted: Mon 05/11/2012 by Deborah Condon www.irishhealth.com]
The high rate of alcohol consumption in Ireland is putting further strain on an already overstretched gastroenterology service, a consultant has warned.
The field of gastroenterology focuses on the digestive system and related disorders. This can include anything from peptic ulcers to acute hepatitis.
According to Dr Gerard Clarke, a consultant gastroenterologist at Portiuncula Hospital in Galway, alcohol not only causes illnesses in its own right, but it can also 'exacerbate the symptoms of almost any other gastrointestinal (GI) condition, from peptic ulcer disease to inflammatory bowel disease'.
He noted that alcohol is a chemical irritant to the upper GI tract and while this is generally related to the consumtpion of spirits, large amounts of other types of alcohol can also cause problems.
He explained that when patients attend their GP with alcohol-related symptoms, they are often referred to a gastroenterologist for an endoscopy - an investigative procedure in which a tiny camera is passed into the body to give a consultant a clear view of the digestive tract.
"However, this can be burdensome, given the existing non-alcohol-related demands for these services," he noted.
Dr Clarke also pointed out that if a patient develops a life-threatening illness, such as acute hepatitis (liver inflammation), they will require care in a high-dependency or intensive therapy unit (ITU), which necessitates 'specific expertise'.
"However, in smaller units with single-handed gastroenterologists, care is compromised by the fact that one person cannot be available 24 hours/seven days a week to optimise management," he explained.
He also noted that when a patient is seriously ill with an alcohol-related illness, they often 'cannot demonstrate abstinence and insight'.
"These patients often require frequent high-intensity intervention and care and again, this can be overwhelming for a single-handed gastroenterologist."
Dr Clarke meanwhile also pointed out that women can present 'as a special problem', because complications usually occur earlier and following less alcohol consumption, compared to men.
"Psychosocial factors may result in a lack of willingness among female patients to be sufficiently open about their problem drinking, which may further compound management difficulties," he explained.
Dr Clarke said that policies such as increasing the price of alcohol or banning the advertisment of products may help to improve the problem of over-consumption. However, he also called for reform and reconfiguration of alcohol services. This should include the establishment of dedicated centres for the residential treatment of alcohol dependence and an increase in the number of gastroenterologists.
"The practice of appointing single-handed gastroenterologists should be abandoned, not only for alcohol-related issues, but also general issues of quality and safety in GI diseases and quality and governance in endoscopy," he added.
Dr Clarke made his comments in Modern Medicine: The Irish Journal of Clinical Medicine.
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