Prevention and treatment of alcoholic liver diseases

Transcription

1 Prevention and treatment of alcoholic liver diseases (Inter)national conference for health professionals Utrecht, November 21, Background The liver is very susceptible to the toxic effects of alcohol. Alcohol use can cause fatty liver, liver inflammation, liver cirrhosis and increase the risk for liver cancer. Still, there is remarkably little public awareness for this severe damage caused by alcohol. Therefore, it is important to spread and share the knowledge and experience present in the Netherlands with regard to treatment and care for people with these severe symptoms. And exactly this is the aim of this conference: present, share and discuss the knowledge and experiences of scientists, specialists and other health professionals. Thus, the conference Prevention and treatment of alcoholic liver diseases intends to communicate the complexity of alcohol and the liver, taking into account the new knowledge and recent practice experiences. After you have attended the conference, you know more about how to recognize, discuss, treat and prevent! Key questions that will be addressed are: - How does alcohol affect the liver; what are the mechanisms of alcoholic liver diseases? - How extensive is the problem of alcoholic liver diseases in Europe and especially in the Netherlands? - How can doctors recognize problematic alcohol use? What is the role of general practitioners? - In what way can general hospitals and addiction institutes cooperate effectively? - What are the main interventions for alcohol dependence? Are these interventions effective? - How is the current infrastructure in general hospitals for patients with an alcoholic liver disease? - Can alcohol clinics for adults be organized to improve this infrastructure? Location: Domstad Utrecht Chairman: Prof. Dr. Martijn Katan (Professor Emeritus Nutrition, VU University Amsterdam) 1

2 Program: Plenary morning session (9:30 12:45): The liver and our health 9:30 9:45: Prof. Dr. Martijn Katan: Welcome 9:45 10:00: Prof. Dr. Peter Anderson: Alcohol and public health 10:00 10:25: Dr. Nick Sheron: Alcoholic liver diseases: Trends in the UK and Europe 10:25 10:50: Prof. Dr. Mark Thursz: Clinical management and EASL policy work Break: 10:50 11:15 11:15 11:45: Prof. Dr. Peter Jansen: 'Alcohol, fuel to the fire of metabolism 11:45 12:15: Prof. Dr. Wim van den Brink: Alcohol dependence 12:15 12:45: Dr. Rob de Man: The role of liver transplantation in the treatment of post alcoholic liver cirrhosis Lunch break 12:45 14:00 Afternoon sessions (14:00 15:15) Session A. Early detection of liver diseases 14:00 14:40: Martijn Sijbom MSc. (general practitioner): Current and future practices of Dutch general practitioners regarding early detection 14:40 15:15: Dr. Nick Sheron: Southampton Traffic Light Test: Effective early detection Sessie B. Motivation to treatment 14:00 14:40: Prof. Dr. Gerard Schippers: How to speak to patients with an alcohol problem: the principles of motivational interviewing 14:40 15:15: Dr. Peter Vossenberg (Tactus): The added value of addiction services to the liver patient Break 15:15 15:45 Plenary closure session (15:45 16:30) 15:45 16:00: Dr. Nico van der Lely: Are the experiences with alcohol clinics applicable for the care of liver patients? 16:00 16:30: Discussion led by Prof. Dr. Martijn Katan Closure 16:30 17:00 2

3 Speakers: Plenary morning session (9:30 12:45) 9:30 9:45: Martijn Kata: Welcome, introduction, discussion with a liver patient Martijn B. Katan is emeritus professor of nutrition at VU University in Amsterdam. He is a member of the Royal Netherlands Academy of Sciences, and a highly cited scientist. His research focuses on diet, heart disease and obesity. Katan is much in demand by the media and writes a column for the leading Dutch newspaper, NRC-Handelsblad. He has expressed concern about the influence of commercial interests on nutrition science. Topic: Martijn Katan will welcome participants, give an overview of the conference, discuss whether moderate alcohol intake is healthy and put questions to Hans Eekman, an alcoholic liver patient. 9:45 10:00: Peter Anderson: Alcohol and public health Peter Anderson is trained as a general practitioner and specialist in public health medicine at the University of Oxford and the London School of Hygiene and Tropical Medicine. His PhD was on the risk of alcohol and what general practitioners can do. He is currently a consultant in addictions policy. He was the regional advisor for both alcohol and tobacco with the European Office of the World Health Organization from 1992 to Since 2001, he has been working as an independent consultant, and has been an adviser in the field of addictions to the European Commission, the World Health Organization (European Regional Office and Headquarters) and many governments and governmental bodies around the world. He was the author of a 400 page report for the European Commission on Alcohol in Europe, translating the evidence base and experience of alcohol policy and prevention programmes for policy makers, programme implementers and researchers. Since 2012, Anderson is professor in Substance Use, Policy and Practice at Newcastle University in the UK and professor in Alcohol and Health at Maastricht University in the Netherlands. Topic: Peter Anderson will provide a broad overview of the consequences of alcohol use for public health in Europe. 3

4 10:00 10:25: Nick Sheron: Alcoholic liver diseases: Trends in the UK and Europe Nick Sheron is an academic, clinical liver doctor (hepatologist) at the University of Southampton and is the head of the liver department of Southampton General Hospital. He conducts a lot of research on alcohol-related problems. He is co-founder of the Alcohol Health Alliance in England, an umbrella organization comprising 27 different organizations with the aim to increase the lobby for "evidence-based" policy to reduce the alcohol-related damage in the UK. He is also a founding member of the European Alcohol and Health Forum, which aims to advise about alcohol strategies in the EU. Topic: In his first, plenary presentation, Nick Sheron will give an overview of the topic alcohol and the liver, will contrast trends in the UK with Europe and will cover the mechanisms for these changes including the role of the industry. 10:25 10:50: Mark Thursz: Clinical management and EASL policy work Mark Thursz is Professor of Hepatology at the Imperial College in London. In the UK, he is very active in promoting the interests of Hepatology as a specialty, and promoting the interests of his patients. Thursz was the Secretary of the British Association for Study of the Liver (BASL) and chaired the British Liver Disease Clinical Interest Group which coordinates multicentre clinical research in liver disease across the UK. Thursz was EASL Vice-Secretary from 2009 to 2011 and Secretary General from 2011 to In these positions, Thursz represented EASL in the European Alcohol and Health Forum (EAHF), a European platform in which he discussed the challenges ahead to reduce alcohol-related harm. By stressing that liver disease is the only top 5 killer in Europe to be on the increase, Thursz aimed to improve policy-makers awareness of the importance of alcoholic liver disease. Topic: Mark Thursz will talk about the clinical management of alcoholic liver diseases and will discuss EASL s influence on European policy makers in order to reduce the number of alcoholic liver patients. Break: 10:50 11:15 4

5 11:15 11:45: Peter Jansen: 'Alcohol, fuel to the fire of metabolism Peter Jansen is professor of gastroenterology and hepatology at the Academic Medical Center in Amsterdam (emeritus since March 2011). His area of expertise includes metabolic, genetic, drug-induced and viral liver disease as well as hepatocellular carcinoma. Peter Jansen has a long track record of serving on governing boards of scientific organizations both in Europe and North America. He is active in postgraduate teaching and lectured throughout Europe, the Middle East, China and Australia. He published over 300 papers. He serves on advisory boards of multicenter studies and is active in advising pharmaceutical companies on the effects of new drugs on the liver. Topic: Peter Jansen will present the metabolism of alcohol in the human body and how alcohol (and its metabolites) affects the liver (and also the pancreas). In his presentation, he illustrates what happens in the body when a person drinks alcoholic beverages. 11:45 12:15: Wim van den Brink: Alcohol dependence Wim van den Brink is professor of Psychiatry and Addiction at the Academic Medical Center of the University of Amsterdam (AMCUvA) and Director of the Amsterdam Institute for Addiction Research (AIAR). His research aims to uncover the neurobiological processes involved in the development of addictive behaviours and the effects of neurobiological interventions to prevent relapse in alcohol dependent patients and pathological gamblers using neuropsychological tests, neurophysiological procedures and/or neuroimaging techniques. He chaired the working group that developed multidisciplinary guidelines for the treatment of alcohol dependence in The Netherlands. He published over 300 papers and is editor of European Addiction Research, associate editor of Drug and Alcohol Dependence and member of the editorial board of Addiction, Addiction Biology, Current Drug Abuse Reviews, International Journal of Methods in Psychiatric Research, Mind and Brain, and Sucht. Topic: Wim van den Brink gives a presentation about addiction in general and more specifically about alcohol dependence. He will present the definition of addiction and which addiction models exist. Then, he gives an overview of effective treatments of alcohol dependence. And he will discuss why only 20% of the alcohol dependent patients visit addiction services and what happens to the other 80%. 5

6 12:15 12:45: Rob de Man: The role of liver transplantation in the treatment of post alcoholic liver cirrhosis Robert A. de Man is Associate professor of Gastroenterology and Hepatology at Erasmus MC. His research focuses on the consequences of decompensated liver disease, liver tumours and viral hepatitis. De Man is keenly interested in education and training and responsible for the training program in gastroenterology at Erasmus MC and chairman of the nationwide MDL education committee. De Man is also interested in the organisation of medical care and quality systems in health care. He is a medical coordinator of the clinical department of Gastroenterology and Hepatology, subsidiary head of the department of Gastroenterology and Hepatology, NIAZ auditor, chairman of the committee in quality audits in Gastroenterology, member of the internal audit committee Erasmus MC, and member of the advisory board patient care Erasmus MC. Topic: Robert De Man will give a presentation about the course of the patient from the moment he is diagnosed with alcoholic liver cirrhosis to his liver transplantation. Topics that he will address are spontaneous recovery of decompensated liver disease after alcohol abstinence indication, selection and timing for liver transplantation as well as the risk of recurrent alcohol abuse post-liver transplantation. Lunch break: 12:45 14:00 Afternoon sessions (14:00 15:15) Session A. Early detection of liver diseases 14:00 14:40: Martijn Sijbom: Experiences of Dutch general practitioners regarding early detection of problematic alcohol use Martijn Sijbom has been registered as a general practitioner since 2009 and is experienced in the general practice of how to care and screen for patients with harmful alcohol use. In 2011, he became scientific employee of the Dutch College of General Practitioners. At this moment he is working on the revision of the Practitioners Standard of Disorders in the use of alcohol. Topic: Martijn Sijbom will present the current practices of Dutch general practitioners (GP s) with regard to early detection of harmful alcohol use. What are the guidelines for GP s, which tools do they use, how successful are they with regard to early detection, which symptoms of alcoholic liver diseases are revealed in the practice, which challenges do GP s meet when encountering problematic alcohol use, etc. As Sijbom is working on the revision of the guidelines with 6

7 regard to early detection of problematic alcohol use, he will shortly present the current state of this revision. 14:40 15:15: Nick Sheron: Southampton Traffic Light Test: Effective early detection CV: See above Topic: In his presentation in Session A, Nick Sheron will talk about the Southampton Traffic Light Test. This is an effective early detection test, especially in combination with the AUDIT- C. Sheron has shown that this test has a great effect on the decrease of alcohol use of patients, even if their test result is green. Is it feasible to implement the STL in GP practices in the Netherlands? Session B. Motivation to treatment 14:00 14:40: Gerard Schippers: How to speak to patients with an alcohol problem: the principles of motivational interviewing Gerard M. Schippers is emeritus professor of Addictive Behaviors and Treatment Evaluation at the Amsterdam Institute for Addiction Research (AIAR). His main topics were implementation of evidence based substance abuse treatment, cognitive behavioral therapy and brief interventions. He published over 150 articles in peer reviewed journals. He is chief editor of the Dutch Journal Verslaving. Schippers has developed the MATE (Measurements in the Addictions for triage and evaluation), a tool to refer patients to substance abuse treatment and evaluate the provided treatment. In addition, he is an expert on Motivational Interviewing and one of the first psychologists who applied this technique in the Netherlands. Schippers is still working as a psychologist and psychotherapist at a psychologists practice, managed by him and his wife. Topic: Gerard Schippers will give an introduction on motivational interviewing. Based on his experiences with alcohol dependent patients, he will explain how motivational interviewing can be effective in the treatment of alcohol dependence. 7

8 14:40 15:15: Peter Vossenberg: The added value of addiction services to the liver patient Peter Vossenberg is medical doctor specialized in addiction medicine and social medicine. Since 1982, he works at an addiction treatment center, Tactus Verslavingszorg. He provides both inpatient and outpatient services for alcohol dependent patients. In addition, he educates students learning for Master in Addiction Medicine. In addition, he is chairman of the Dutch Society for Addiction Medicine (VVGN). Topic: In his presentation, Peter Vossenberg will articulate the added value of addiction services for general hospitals dealing with alcohol dependent patients. He will present the current activities of addiction services: which treatments are available for these patients, what is the outcome of these treatments and what happens after these patients are being treated. In addition, Vossenberg will talk about the current cooperation between general hospitals and addiction services, whether this cooperation can be improved and what the consequences are of an improved cooperation. Break: 15:15 15:45 Plenary closure session (15:45 16:30) 15:45 16:00: Nico van der Lely: Are the experiences with alcohol clinics applicable for the care of liver patients? Dr. Nico van der Lely is pediatrician at the Reinier de Graaf Hospital in Delft, where he studies alcohol and youth and alcohol prevention. The increasing number of cases of alcohol poisoning was the reason why Van der Lely set up an outpatient clinic Youth and Alcohol in 2006, together with child and adolescent psychologist Mireille de Visser. He believes it is very important that we guard our children against the dangers of alcohol. Netherlands now has five alcohol clinics supported by him, in which aftercare plays a central role. Once a young person recovers from his or her coma, a team of educators and psychologists is ready to ensure that repetition is avoided. In addition to his work in the hospital, he helps municipalities and other parties with their alcohol projects. Topic: Nico van der Lely will present his experiences with setting up an outpatient alcohol clinic. The results of this clinics are presented. These alcohol clinics are a good example of an improved medical infrastructure for alcohol dependent patients as illustrated by experiences of his patients. 8

9 16:00 16:30: Discussion led by Katan CV: See above Topic: Martijn Katan will chair a discussion on the treatment of alcoholic liver patients. What is the role of the GP, the liver doctor, the addiction therapist, the nurse and the social worker? How can this infrastructure be improved? Is it feasible to implement the Southampton Traffic Light Test in the Netherlands? What could outpatient clinics according to the model of Nico van der Lely contribute to treatment of alcohol-dependent adults? Closure with drinks and bites 16:30 17:00 9