Secondary to vitamin deficiencies, alcoholics suffer from inflammation of the tongue (glossitis), inflammation of the mouth (stomatitis), caries, and perio-dontitis. A low-protein diet, associated with alcoholism, can lead to a zinc deficiency, which impairs the sense of taste and further curbs the appetite of the alcoholic. Parotid gland enlargement may be noted.
Alcohol causes decreased peristalsis and decreased esophageal sphincter tone, which leads to reflux esophagitis with pain and stricture formation (Bor et al., 1998). The Mallory-Weiss syndrome refers to a tear at the esophageal-gastric junction caused by intense vomiting. Another source of bleeding from the esophagus is esophageal varices secondary to the portal hypertension of cirrhosis.
Alcohol decreases gastric emptying and increases gastric secretion. As a result, the mucosal barrier of the gastrium is disrupted, allowing hydrogen ions to seep into the mucosa, which release histamine and may cause bleeding. Acute gastritis is characterized by vomiting (with or without hematemesis), anorexia, and epigastric pain. It remains unclear whether chronic alcohol abuse increases the risk of ulcer disease.
The small intestine shows histological changes and contractual pattern changes even with adequate nutrition. Acute alcohol consumption impairs absorption of folate, vitamin B12, thiamine, and vitamin A, as well as some amino acids and lipids. Intestinal enzyme activity is altered as well (Hauge, Nilsson, Persson, & Hultberg, 1998).
Alcohol consumption and gallstones are the two most common causes of acute pancreatitis. Alcohol in moderate amounts does not increase the risk for acute pancreatitis, but consumption of 35 or more drinks per week increases the odds ratio to 4.1 (Blomgren et al., 2002). Acute pancreatitis presents as a dull, steady epigastric pain that may radiate to the back. Bending or sitting may partially relieve the pain, confirming its retroperitoneal origin. Pain may be precipitated or aggravated by meals and relieved by vomiting. A serum amylase of 1.5 to 2.0 times the upper limit of normal has a sensitivity of 95% and a specificity of 98% for acute pancreatitis. Ethanol-induced acute pancreatitis is the result of the toxic effect of ethanol on pancreatic acinar cells, leading to inflammation and release of proteolytic enzymes. Chronic pancreatitis is caused most commonly by alcoholism. The common presenting symptoms are abdominal pain, weight loss, nausea, vomiting, jaundice, and diarrhea. Surgical procedures are available for treatment of chronic pancreatitis, with favorable long-term results (Sohn et al., 2000).
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