Alcohol-Related Organ Complications Increasing in Teens, Young Adults

Alcohol-associated pancreatitis and liver disease have been increasing among adolescents and young adults, according to a retrospective population-based cohort study from Canada.

From 2003 to 2021, the incidence of pancreatitis increased by 7% per year in males (rate ratio [RR] 1.07, 95% CI 1.06-1.08) and 12% per year in females (RR 1.12, 95% CI 1.10-1.13), while liver-related complications increased by 6% per year in males (RR 1.06, 95% CI 1.05-1.07) and 9% per year in females (RR 1.09, 95% CI 1.08-1.11), reported Jennifer A. Flemming, MD, of Queen’s University in Kingston, Ontario, and colleagues.

Meanwhile, rates of end-organ alcohol harm in other organs decreased by 1% per year in males (RR 0.99, 95% CI 0.98-0.99) and increased by 2% per year in females (RR 1.02, 95% CI 1.01-1.02), they wrote in JAMA Network Open.

Among the 11,508 adolescents and young adults with an incident end-organ complication from alcohol, pancreas-related complications were more frequent than liver-related complications (29% vs 19%, respectively), and 92% of pancreatic complications were acute pancreatitis. Compared with those with other end-organ complications, those with pancreas-related complications were more likely to be male (71%), live in urban locations (88%), and require hospitalization (77%).

“Our findings suggest that gastrointestinal complications from alcohol are increasing in AYAs [adolescents and young adults] at rates much higher than in other organ systems,” Flemming and team noted. “Males were most affected by both pancreatitis and ALD [alcohol-associated liver disease], yet young females had changes in the rates of alcohol-associated pancreatitis and ALD that were higher than males.”

“Similar to ALD, males and females may have a different risk of acute and chronic pancreatitis for the same level of alcohol exposure,” they noted.

“It is unclear what factors are associated with this rise in disease burden,” they added. “Although changes to administrative coding or better case definition could be contributing factors, we did not observe these changes in other end organs, such as the stomach and heart.”

“These findings underscore the importance of gastroenterologists in caring for individuals with harmful alcohol use and support the integration of addiction medicine into gastroenterology training along with consideration for multidisciplinary gastroenterology-addiction medicine clinics,” they concluded.

Bubu A. Banini, MD, PhD, of the Yale School of Medicine and the Yale Liver Center in New Haven, Connecticut, told MedPage Today that she was unsurprised by the study’s findings.

“In the United States, recent studies show uptrend in alcohol-associated liver disease in young adults, especially young adult females, over the past few decades,” she said. Though not involved in this study, she led a similar study that found an increase in alcohol-associated hepatitis deaths from 1999 to 2020, with the steepest increase seen among adults ages 25 to 34.

“Liver and pancreas damage are only two of the several gastrointestinal complications associated with excess alcohol consumption, and unfortunately many of the complications may go undetected and unaddressed in healthcare settings until they are severe,” Banini noted. “Healthcare professionals, individuals, and communities should be aware of the detrimental effects of alcohol, so that excess use can be addressed to prevent end-organ damage.”

For this study, the researchers used administrative healthcare data from ICES (formerly the Institute for Clinical Evaluative Sciences) from 2003 to 2021 to identify incident emergency department or inpatient encounters for end-organ alcohol-related harm in individuals ages 13 to 39. Encounters were categorized by organ: pancreas (alcohol-associated acute and chronic pancreatitis); liver (ALD, alcohol-associated hepatitis, alcohol-associated cirrhosis); and other organs (stomach, adrenal glands, nervous system, muscles, heart, and fetus).

They included 11,508 adolescents and young adults in this analysis. Median age was 28, and 64% were males.

The study was limited by a lack of data on how much alcohol patients had consumed and the severity of their condition at presentation.

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