Don't wanna ride that Whiskey Train
By Xia & He Publishing Inc.
 |
| Brackets indicate an increased risk of developing cancer, although the relationship is not yet fully established. Credit: Roberto De Giorgio, Fabio Caputo |
The liver, responsible for breaking down alcohol, suffers
immense damage, leading to cirrhosis and even liver cancer. Meanwhile, the
stomach and intestines experience erosion, ulcers, and nutrient malabsorption.
The pancreas is at risk for life-threatening pancreatitis, while the
gallbladder can develop painful gallstones. Even more alarming, alcohol
significantly raises the risk of deadly gastrointestinal cancers. Reducing
alcohol intake is the best way to protect digestive health and prevent
irreversible damage.
The Hidden Toll of Alcohol on Digestive Health
Excessive alcohol consumption is a major public health
issue, contributing to 6% of all deaths worldwide and 5.1% of the global
disease burden. It is a key risk factor for more than 200 diseases, including
liver cirrhosis, pancreatitis, and esophageal cancer, with particularly severe
effects on the digestive system. More than half of alcohol-related deaths are
linked to gastrointestinal diseases, underscoring the need to understand how
alcohol affects digestion. This review explores how the body processes ethanol
and how alcohol consumption contributes to diseases affecting the liver,
gastrointestinal tract, pancreas, and gallbladder.
Liver
The liver is the primary site of alcohol metabolism,
processing about 90% of the alcohol a person consumes. Once inside the liver,
ethanol is broken down into acetaldehyde by the enzyme alcohol dehydrogenase
(ADH). Acetaldehyde, a highly toxic substance, is then converted into acetate,
which eventually breaks down into carbon dioxide and water.
However, acetaldehyde can cause significant damage to liver
cells, leading to a range of liver diseases. These include fatty liver
(steatosis), liver inflammation (steatohepatitis and alcoholic hepatitis),
scarring (fibrosis and cirrhosis), and even liver cancer (hepatocellular
carcinoma or HCC). Chronic alcohol use speeds up liver damage, and factors such
as genetics and the type of alcohol consumed can influence disease progression.
Women are particularly vulnerable to alcohol-related liver damage due to differences
in metabolism and body composition, making them more susceptible to long-term
harm.
Gastrointestinal Tract
The gastrointestinal tract is often the first to show damage
from excessive alcohol consumption, which can cause both reversible and
irreversible lesions. Alcohol can lead to stomatitis, periodontal disease, and
alterations in the oral microbiota. In the esophagus, alcohol’s toxic effects
contribute to esophagitis, gastroesophageal reflux disease, and an increased
risk of esophageal cancer, particularly when combined with smoking.
Alcohol also affects gastric motility and mucosal integrity,
contributing to conditions like gastritis, peptic ulcers, and eventually
gastric cancer. Chronic alcohol use can impair intestinal barrier function,
leading to “leaky gut,” dysbiosis, and nutrient malabsorption. These changes
increase the risk of diarrhea and contribute to colorectal cancer development.
Pancreas
Alcohol misuse is a leading cause of pancreatitis. Acute
pancreatitis (AP) and chronic pancreatitis are common consequences of alcohol
consumption. In AP, excessive alcohol intake leads to inflammation and
pancreatic tissue damage, while chronic pancreatitis involves persistent
inflammation, fibrosis, and pancreatic insufficiency.
The pathophysiology of alcohol-induced pancreatitis is
multifactorial, involving both direct toxic effects on pancreatic cells and
indirect effects through the activation of inflammatory and fibrotic pathways.
Pancreatic cancer is also a severe consequence of long-term alcohol abuse, with
alcohol serving as a cofactor in the disease’s development, particularly when
combined with smoking.
Gallbladder
Alcohol consumption is associated with an increased risk of
gallstones and gallbladder disease. Alcohol can alter bile composition,
contributing to the formation of gallstones, and chronic alcohol use can lead
to gallbladder inflammation, resulting in conditions like cholecystitis.
Additionally, alcohol abuse can exacerbate pre-existing gallbladder issues by
increasing oxidative stress and promoting the secretion of inflammatory
cytokines.
Gastrointestinal Tumors
Alcohol is a significant risk factor for various
gastrointestinal cancers, particularly those in the esophagus, stomach, and
colon. Ethanol metabolism produces acetaldehyde, a potent carcinogen that can
damage DNA, inhibit DNA repair, and shorten telomeres, contributing to
carcinogenesis. Alcohol consumption, particularly in combination with smoking,
significantly increases the risk of esophageal squamous cell carcinoma and
gastric cancer. It is also associated with an elevated risk of colorectal
cancer through mechanisms like DNA methylation induced by alcohol.
Discussion
Chronic alcohol consumption results in a broad spectrum of
damage across the digestive system, from the oral cavity to the rectum. The
severity of the damage depends on factors such as the amount and frequency of
alcohol intake, genetic predisposition, and the presence of other risk factors.
The interaction of alcohol with other drugs, particularly in women, can further
exacerbate its harmful effects. Acetaldehyde and endotoxemia triggered by
alcohol intake play critical roles in liver damage, leading to conditions like
cirrhosis and liver cancer. Early detection and management of alcohol-induced
damage are essential to prevent progression to more severe conditions like
pancreatitis, cirrhosis, and cancer.
Conclusions
Minimizing alcohol intake is crucial for digestive health.
Social drinking, defined as up to one drink per day for women and two drinks
per day for men, is considered the safest approach. Individuals with alcohol
use disorder should seek professional support and management to reduce the risk
of gastrointestinal damage. Immediate medical evaluation is recommended for
patients who present with persistent digestive symptoms linked to excessive
alcohol consumption.
Reference: “Effects of Ethanol on the Digestive System: A
Narrative Review” by Fabio Caputo, Matteo Guarino, Alberto Casabianca, Lisa
Lungaro, Anna Costanzini, Giacomo Caio, Giorgio Zoli and Roberto De Giorgio,
2024, Journal of Translational Gastroenterology.
DOI:
10.14218/JTG.2024.00028
