The effects of alcohol on gastrointestinal tract, liver and pancreas: evidence-based suggestions for clinical management.

Alcohol has a direct impact on the digestive system due to its contact with mucosal lining and interference with digestive functions. Various diseases of the gastrointestinal tract, including tumors, may be related to an excess of alcohol intake and the relationship between alcohol abuse and hepatic and pancreatic damage is well established. According to WHO, alcohol and alcohol-related diseases represent a major health problem and will probably continue to do so in the foreseeable future. In this review, we summarize the present knowledge on clinically relevant alcohol-related problems in order to provide practicing physicians with evidence-based general suggestions which might help in the management of alcohol-related gastrointestinal disorders. A thorough clinical history together with a number of questionnaires are essential for detecting alcohol dependence or abuse. Biochemical tests (nonspecific and specific) have been considered to be less sensitive than questionnaires in screening for alcohol abuse, but they may be useful in identifying relapses. Protracted behavior modification, cognitive behavioral therapy, psychological counseling, and mutual support groups have been considered the most effective long-term treatments. Several drugs have been developed that are able to interfere with the neurotransmitters involved in craving mechanisms, and we summarize the evidence of their efficacy to increase abstinence and to prevent relapse.

Hip fracture in nursing homes: an Italian study on prevalence, latency, risk factors, and impact on mobility.

Hip fracture may cause and/or complicate institutionalization. We undertook this study to define its overall prevalence among the residents of four nursing homes in Central Italy as well as its latency and impact on mobility when it occurred within institutions. We also performed a case control analysis with the aim of identifying potential risk factors for hip fracture in nursing home. Among the 211 residents (160 women, mean age 82.2 +/- 9.29 years, and 51 men, mean age 77.1 +/- 8.9 years), 42 were hip fracture cases, with a prevalence of almost 20%, and a female/male ratio of 6/1.23 fractures preceded institutionalization; of these 19 (17 females and 2 males) occurred within the nursing homes (mean age 83.2 +/- 6.3 years). The average interval between institutionalization and fracture was 74.2 months. The impact of hip fracture on mobility was relevant. The percentage of residents ambulating autonomously fell from 95% to 32% among those who had fractured. Fractured subjects were characterized by worse mobility and function than unfractured subjects, while comorbidity, cognitive functions, and use of psychotropic drugs were similar. Prefracture mobility of fractured subjects was better than that of age-and sex-matched residents who had never fractured their hip. Regarding hip fracture in our nursing home population we can conclude that (1) hip fracture is one of the main causes of institutionalization; (2) in most cases hip fracture occurred late in the course of the nursing home stay; (3) the functional impact of the fracture was relevant when it occurred in institutions. We also suggest that preserved mobility may represent an additional risk factor for hip fracture in nursing homes.