VOLUME 49 SUPPLEMENT 3 2 October 2017 ISSN 1590-8658

Abstracts of the A.I.S.F. - Italian Association for theStudy of the Liver - Monothematic Conference “Alcoholic Liver Disease: The New Challenge”

Rome, October 4th-5th-6th, 2017

An International Journal of Gastroenterology and Hepatology

Digestiveand Liver Disease

Italian Association for the Study of the Liver (AISF)Italian Association for the Study of the Pancreas (AISP) Italian Association for Digestive Endoscopy (SIED)Italian Society of Gastroenterology (SIGE)

Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP)Italian Group for the Study of Infl ammatory Bowel Disease (IG-IBD)Fédération Francophone de Cancérologie Digestive (FFCD)

SECTION EDITORSAlimentary Tract

Colm O’Morain, Dublin, Ireland

Basic ScienceGianfranco Alpini, Temple, USA

Romina Mancinelli, Rome, Italy

Theresa T. Pizarro, Cleveland, USA

Digestive EndoscopyAndres Cardenas, Barcelona, Spain

Arnulf Ferlitsch, Vienna, Austria

Cesare Hassan, Rome, Italy

Helmut Neumann, Mainz, Germany

Emanuele Rondonotti, Como, Italy

Digestive OncologyThomas Aparicio, Paris, France

Côme Lepage, Dijon, France

General GastroenterologyMaura Corsetti, Leuven, Belgium

Nicola de Bortoli, Pisa, Italy

Edoardo Savarino, Padua, Italy

Radu Tutuian, Bern, Switzerland

Umberto Volta, Bologna, Italy

ImagingAnnalisa Berzigotti, Bern, Switzerland

Cristina Bezzio, Garbagnate Milanese, Italy

Federica Furfaro, Rozzano, Italy

Giovanni Maconi, Milan, Italy

Infectious DiseaseAntonella D’Arminio Monforte, Milan, Italy

Infl ammatory Bowel DiseaseAlessandro Armuzzi, Rome, Italy

Emma Calabrese, Rome, Italy

Stephen Collins, Hamilton, Canada

Peter Lakatos, Montreal, Canada

Liver DiseasePietro Andreone, Bologna, Italy

Tarik Asselah, Clichy, France

Jaime Bosch, Barcelona, Spain

Maurizia Brunetto, Pisa, Italy

Patrizia Burra, Padua, Italy

Alessia Ciancio, Turin, Italy

Alessandra Dell’Era, Milan, Italy

Maria Francesca Donato, Milan, Italy

Rafael Esteban Mur, Barcelona, Spain

Anna Ludovica Fracanzani, Milan, Italy

Vincenzo La Mura, San Donato Milanese, Italy

Ana Lleo, Milan, Italy

Valerio Nobili, Rome, Italy

Salvatore Petta, Palermo, Italy

Fabio Piscaglia, Bologna, Italy

Pancreatic DiseaseGabriele Capurso, Rome, Italy

Alberto Malesci, Milan, Italy

Pediatric GastroenterologySalvatore Cucchiara, Rome, Italy

SurgeryMassimo Falconi, Milan, Italy

Roberto Santambrogio, Milan, Italy

Statistical ConsultantFederico Ambrogi, Milan, Italy

Editors EmeritiGabriele Bianchi-Porro, Milan, Italy

Mario Angelico, Rome, Italy

Editor in ChiefRoberto de Franchis, Milan, Italy

Co-EditorsSavino Bruno, Milan, Italy

Silvia Fargion, Milan, ItalyMaurizio Vecchi, San Donato Milanese, Italy

Managing EditorSilvia Malosio, Milan, Italy

Editorial AssistantBrenda Dionisi, Milan, Italy

EDITORIAL BOARD

Waddah A. Alrefai, Chicago, USA

Domenico Alvaro, Rome, Italy

Angelo Andriulli, Foggia, Italy

Paolo Angeli, Padua, Italy

Adolfo Francesco Attili, Rome, Italy

Gabrio Bassotti, Perugia, Italy

Laurent Beaugerie, Paris, France

Robert Benamouzig, Bobigny, France

Antonio Benedetti, Ancona, Italy

Marc Benninga, Amsterdam, Netherlands

Marina Berenguer, Valencia, Spain

Roman Bogorad, Cambridge, USA

Jean-Pierre Bronowicki, Vandoeuvre-Lès-Nancy, France

William R. Brugge, Boston, USA

Elisabetta Buscarini, Crema, Italy

Nicola Caporaso, Naples, Italy

Carlo Catassi, Ancona, Italy

Umberto Cillo, Padua, Italy

Agostino Colli, Lecco, Italy

Dario Conte, Milan, Italy

Gino Roberto Corazza, Pavia, Italy

Enrico Corazziari, Rome, Italy

Antonio Craxì, Palermo, Italy

Gianfranco Delle Fave, Rome, Italy

A. Jack Demetris, Pittsburgh, USA

Sharon DeMorrow, Temple, USA

Philippe Ducrotte, Rouen, France

Amal Dutta, Dallas, USA

Stefano Fagiuoli, Bergamo, Italy

Massimo Fantini, Messina, Italy

P. Marco Fisichella, Boston, USA

Heather Francis, Temple, USA

Mirella Fraquelli, Milan, Italy

Dennis Freshwater, Birmingham, UK

Giovanni Battista Gaeta, Naples, Italy

Antonio Gasbarrini, Rome, Italy

Eugenio Gaudio, Rome, Italy

Stefano Ginanni Corradini, Rome, Italy

Shannon Glaser, Temple, USA

Pietro Invernizzi, Milan, Italy

Robert Jensen, Baltimore, USA

Michel Kahaleh, New York, USA

David Laharie, Pessac, France

René Laugier, Marseille, France

Astrid Lièvre, Saint-Cloud, France

Patrick Maisonneuve, Milan, Italy

Riccardo Marmo, Salerno, Italy

Marco Marzioni, Ancona, Italy

Carlo Merkel, Padua, Italy

David Mutimer, Birmingham, UK

Mattijs Numans, Leiden, Netherlands

Jean Marc Phelip, Saint Etienne, France

Paola Piccolo, Rome, Italy

Antonio Pinna, Bologna, Italy

Massimo Puoti, Milan, Italy

Franco Radaelli, Como, Italy

Alessandro Repici, Milan, Italy

Oliviero Riggio, Rome, Italy

Mario Rizzetto, Turin, Italy

Renato Romagnoli, Turin, Italy

Massimo Rugge, Padua, Italy

Tilman Sauerbruch, Bonn, Germany

Jean-Cristophe Saurin, Pierre-Benite, France

Vincenzo Savarino, Genoa, Italy

Laurent Siproudhis, Rennes, France

Etienne Sokal, Brussels, Belgium

Mario Strazzabosco, New Haven, USA

Giacomo Carlo Sturniolo, Padua, Italy

Pier Alberto Testoni, Milan, Italy

Guiseppe Tisone, Rome, Italy

Michael Trauner, Vienna, Austria

Vincenzo Villanacci, Brescia, Italy

Frank Zerbib, Bordeaux, France

Huiping Zhou, Richmond, USA

Official Journal of:

Vol. 49 Supplement 3 (2017)

Contents Vol . 49 Supplement 3 ( 2 October 2017 )

Index Medicus (MEDLINE), Current Contents/Clinical Practice,Science Citation Index and EMBASE/Excerpta Medica

Sociedad Iberoamericana de Información Cient ı́fi ca (SIIC)

Associato alla Unione Stampa Periodica Italiana

Abstracts of the A.I.S.F. Monothematic Conference 2017: Oral Communications e237

Abstracts of the A.I.S.F. - Italian Association for theStudy of the Liver - Monothematic Conference “Alcoholic Liver Disease: The New Challenge”

Rome, October 4th–5th–6th, 2017

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Contents lists available at ScienceDirect

Digestive and Liver Disease

journa l homepage: www.e lsev ier .com/ locate /d ld

ISF Monothematic “Alcoholic Liver Disease: The New

hallenge” – Auditorium Antonianum Rome, October 4th-5th-6th017

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lcohol consumption survey in an outpatiententer of gastroenterology in southern Italy

. Abenavoli 1,∗, P.H. Guzzi 2, F. Luzza 1,. De Lorenzo 3, G. Addolorato 4

Department of Health Sciences, University “Magnaraecia”, Catanzaro, ItalyDepartment of Surgical and Medical Sciences,niversity of Catanzaro, Catanzaro, ItalyDepartment of Biomedicine and Prevention,niversity “Tor Vergata”, Rome, ItalyDepartment of Medical Sciences, Hepatology andastroenterology Unit, Catholic University of Rome,

taly

Background: Italy ranks first among the European countries inerms of wine production and tenth for annual pro-capita alcoholonsumption. However, there are noteworthy regional differencesnd in particular between northern and southern regions. Fewtudies have analysed the alcohol consumption in different socialontexts in order to better understand the relationship betweennvironmental, cultural, and personal variables.

Aim: Investigate alcohol consumption and drinking habits by aelf-made questionnaire, in a cohort of patients afferent to an out-atient center of gastroenterology, in the Tinchi Hospital (Matera),asilicata, Italy.

Materials and methods results: In total 680 nonconsecutiveatients, 321 (47.2%) male, were recruited in this survey fromecember 2011 to June 2012. Median age of our cohort was 52.17 (±7.34) years. Patients were included in the following disease cate-ories: 198 (29%) reflux disease, 170 (25%) gastritis, 59 (8.7%) gastricnd/or duodenal ulcer, 28 (4%) hemorrhoids, 23 (3.4%) chronic liverisease, 14 (2.1%) liver cirrhosis and 189 (27.8%) miscellaneousi.e. functional gastrointestinal disorders, dolicocolon, diverticularisease). In this cohort, 241 (35.44%) were abstinent, 255 (37.50%)ccasional drinkers, and 184 (27.06%) daily drinkers. In drinkers,

he prevalent alcoholic beverage was wine in 470 (69.12%), beer in62 (38.53%), liquor in 102 (14.85%). Daily drinking was found toe more common in males (184) than in females (128) (p < 0.05). Inarticular, in male patients, age, low social level, and unhappiness

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were slightly (p = 0.1) associated with alcohol intake. Smoking(p < 0.05) and lower physical (p < 0.05), intellectual (p < 0.05), social(p < 0.05), and cultural activities (p < 0.05) were associated withalcohol consumption. Furthermore, drinking profile was associated(p < 0.05) with upper gastrointestinal diseases cluster.

Conclusions: Our data show that, according to a Mediterraneanlife-style, alcohol intake was common in a southern Italy cohort ofpatients. Furthermore, data indicate that social, demographic, andcultural factors may influence alcohol intake.

http://dx.doi.org/10.1016/j.dld.2017.08.005

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Hospital dismissal data sheets on alcoholic liverdiseases into three first aid divisions:A southern Italy survey

M. Dallio 1,∗, G.G. Caprio 1, V. Ormando 1,F. Paladino 2, C. Toscano 3, G. Cotticelli 1,C. Loguercio 1, A. Federico 1

1 Hepatogastroenterology Division, University ofCampania “L. Vanvitelli”, Naples, Italy2 Cardarelli Hospital, Naples, Italy3 Villa d’Agri Hospital, Potenza, Italy

In 2010, the Health World Organisation identified alcohol asone of the prevalent evitable risk’s factors in the development ofliver and systemic diseases. Epidemiological data represent essen-tial instruments to plan and realize prevention’s strategies and toreduce detrimental alcohol consumption.

In Italy, last epidemiological data registered in 2012 show 1308deaths (0.21%) for alcohol-related pathologies out of 612,833 totaldeath. Hospital dismissal data sheets dating from 2014 report67,844 alcohol-related disorders (0.71% of total Italian hospital dis-missal data sheets). 0.38% of these disorders were related to liverdiseases and the gender prevalence was 78% males and 22% females(0.6% less than 18 years old) in the analysed population.

We analysed hospital dismissal data sheets belonging to three

First Aid Divisions in Southern Italy in 2015.

We reported 116,535 First Aid’s admissions: of these 191(0.16%) were alcohol-related. Acute alcohol ingestion was found

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n 84 patients (44%, M/F = 80/4; 15 foreigners, 11 less than 18 yearsld) and alcoholic-related liver diseases in 70 patients (5 acuteepatitis, M/F = 4/1 and 65 liver cirrhosis, M/F 59/6; 24 foreigners,less than 18 years old).

Our data show the recourse for alcohol related disorders toirst Aid Division of three Southern Italy’s Hospitals is lower thantalian data (0.16% versus 0.71%, respectively), probably becauselcoholic ingestion is not recognised as damage cause. By analyz-ng the population study, we discovered that the major risk groups

ere teenagers and foreigners. Probably, in these patients, pre-entive strategies should be addressed to avoid alcoholic relatedisorders. Alcoholic anamnesis is crucial to identify prevention’strategies, since all alcohol-related pathologies are evitable.

ttp://dx.doi.org/10.1016/j.dld.2017.08.006

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ospital admissions for alcoholic and notlcoholic liver cirrhosis in Sicily (2007/2016)

. Butera 1,∗, G. Dardanoni 2, G. Fantaci 2,. Arnone 3, M. Maringhini 4, A. Maringhini 1

Department of Internal Medicine, Ospedale Civicoenfratelli, Palermo, ItalyD.A.S.O.E., Ospedale Civico Benfratelli, Palermo,

talyStatistics and Informatic System, Ospedale Civicoenfratelli, Palermo, ItalyDepartment of Internal Medicine, University ofalermo, Palermo, Italy

Introduction: The leading causes of cirrhosis in Italy are alcoholntake, B and C Hepatitis viruses and metabolic syndrome. Accord-ng to the Italian Institute of Statistics (ISTAT) the mortality rateor liver cirrhosis has decreased from 34.5 (1980) to 10.8/100,0002012). This favourable trend is due to the improvement of treat-

ents and to a decreasing role of HBV and HCV infections. Onlyelected hospital based-series have showed this reduction for HBVnd HCV related cirrhosis. These studies may be biased by patientelection.

Aim: We investigated the hospital admission trend in the last0 years in all cirrhotics that were admitted in all Sicilian hospitals.

Materials and methods results: All DRG of patients admittedn Sicilian public and private hospitals, from 1st January 2007 to1st December 2016 were investigated for: number of dimissions,tiology (alcoholic or not alcoholic), complications and age. Notlcoholic cirrhosis (NAC)/1000 hospitalized patients decreasedrom 11.1 (2007) to 10.1/1000 (2016). The cumulative number ofAC decreased from 7862 to 5103. Alcoholic cirrhosis (AC)/1000

ncreased from 1.4 to 1.8/1000. The cumulative number of ACecreased from 988 to 910. Total admissions in Sicily for any dis-ase decreased from 708189 to 504197. Mean age of NAC increasedrom 68.2 to 70.0 years old. Mean age of AC increased from 57.1o 59.6 years old. Main complications from 2007 to 2016 showedhe following trend for NAC/AC. HCC: 17.0–22.0%/5.5–13.9%;oma: 10.8–10.5%/8.5–9.7%; Ascites: 19.5–25.8%/22.5–30.8%;epato-renal syndrome: 1.3–1.9%/1.8–2.9%; Hematemesis:.2–1.5%/2.4–1.6%; Melena: 1.4–1.4%/1.6–1.3%.

Conclusions: In Sicily total admissions for any disease in the last0 years decreased of 28.8%. In the same period NAC/1000 hospital-

zed decreased, AC increased. HCC, ascites, epato-renal syndromeere more prevalent at the end of the observation period.

ttp://dx.doi.org/10.1016/j.dld.2017.08.007

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Blood alcohol concentration changes inlaboratory samples during refrigerated storage

L. Abenavoli 1,∗, M. Maletin 2, D. Stojic 3, S. Brkic 4,G. Stojiljkovic 2

1 Department of Health Sciences, University “MagnaGraecia”, Catanzaro, Italy2 Institute of Forensic Medicine Clinical Center ofVojvodina, Medical Faculty, University of Novi Sad,Novi Sad, Serbia3 Faculty of Economics, University of Novi Sad, NoviSad, Serbia4 Faculty of Medicine, Clinic for Infectious Diseases,University of Novi Sad, Novi Sad, Serbia

Background: Stability of blood alcohol concentration (BAC) inlaboratory samples is very important when it is necessary to per-form repeated analyses.

Aim: Evaluate the stability of alcohol in blood specimensobtained from living persons, stored for 6 months in a refrigeratedstate at −18 ◦C, which were intermittently opened two times dur-ing the storage, mimicking possible quality control sampling and/orcourt orders for repeated analyses.

Materials and methods results: We have analyzed the stabilityof BAC in 50 samples, which were taken from apprehended drivers,kept at −18 ◦C, without preserving agents. Quantitative analyseswere performed using headspace sampling gas chromatography(HS-GC) with flame ionizing detection (FID). Samples were ana-lyzed immediately after collection (C1), and after 60 (C60), 120(C120) and 180 (C180) days. A group of 50 samples, which werekept closed for 180 days at −18 ◦C, was utilized as a control. Wefound a significant decrease in BAC between C1 and C180 (= 0.224;SD = 0.144; t = 10.98; p < 0.001), and between C1 and C60, C60 andC120, C120 and C180. There was a significant positive correla-tion (r = 0.8) between starting concentration C1, and the value ofBAC changes (�C). Linear regression analysis (R2 = 0.64) implies thedegree of validity to the proposed model of �C change regardinginitial BAC. There were significant changes in �C between the twogroups.

Conclusions: Our data underline the significance of air chamberpercent (CA%) and ethanol evaporation due to ventilation betweenliquid and gas phase as a mechanism of ethanol decay.

http://dx.doi.org/10.1016/j.dld.2017.08.008

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Early liver transplantation for severe acutealcoholic hepatitis: Pilot program in a singletransplant centre in Italy

G. Germani 1,∗, E. Romandini 1, A. Ferrarese 1,A. Zanetto 1, M. Gambato 1, M. Senzolo 1,F.P. Russo 1, F. D’Amico 2, U. Cillo 2, P. Burra 1

1 Multivisceral Transplant Unit, Padova UniversityHospital, Italy2 Hepatobiliary Surgery and Liver Transplantation,Padova University Hospital, Italy

Background: Acute alcoholic hepatitis (AAH) is a clinical syn-drome characterized by high mortality rates. There is increasing

evidence that early liver transplantation (LT), performed withinstrict and standardized protocols, can improve survival.

Aims: The aims of the study were: a) to evaluate demo-graphic and clinical features of patients with severe AAH; b)

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o assess survival in LT patients for severe AAH; c) to compareutcomes of these patients with those patients with severe AAHon-responding to medical therapy excluded from LT.

Material and methods: We included patients admitted forevere AAH at Multivisceral Transplant Unit of Padua Universityospital (January 2013–June 2017). Demographic, biochemical andlinic characteristics were evaluated. Patients not responding toedical therapy were placed on the waiting list for LT only if theyere considered suitable candidates by a strict selection process.

Results: 20 patients with severe AAH were evaluated (50%omen), with a median age of 45.5 years. 13/20 (65%) were not

esponders to medical therapy and underwent the selection pro-ess. Amongst these, 6 patients were placed on the waiting list.edian time from admission to placement on the waiting list was

8.5 days (6–41 days). Survival at 6 months after liver transplan-ation was significantly higher in patients with severe AAH whonderwent LT compared with patients who were considered notuitable for LT (100% vs. 43%; p = 0.0339). Median hospitalizationime after LT was 18.5 days. None of LT patients experience alcoholelapse during the follow-up (median: 19.7 months). LT for severeAH accounted for 1.2% of total LT performed from 2013 to 2017nd for 8.3% of LT performed for alcohol-related liver disease.

Conclusions: Early LT significantly improve survival in severeAH no-responding to medical therapy, when a strict selectionrocess is applied. Further studies are needed to properly assesslcohol relapse with a longer follow-up.

ttp://dx.doi.org/10.1016/j.dld.2017.08.009

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utritional assessment in alcohol relatedisorders: Results from a cross sectional studyn hospitalized patients

. Rinninella 1,∗, M. Cintoni 1, L. Basso 1, S. Leone 1,. Egidi 1, G. Vassallo 2, M. Antonelli 2, C. Tarli 2,. Addolorato 2, A. Gasbarrini 2, G.A.D. Miggiano 1,.C. Mele 1

Clinical Nutrition, Area Gastroenterologia,ondazione Policlinico Universitario Agostinoemelli, Catholic University of Sacred Heart, Rome,

talyInternal Medicine and Gastroenterology,ondazione Policlinico Universitario Agostinoemelli, Catholic University of Sacred Heart, Rome,

taly

Introduction: Malnutrition is recognized as a frequent com-lication in alcoholic liver disease. Recently, several malnutritioncreening and assessment tools have been recognized in clinicalractice [1].

Materials and methods: We enrolled patients affected bylcoholic-related disorders in our Internal medicine and Gastroen-erology ward between March and July 2017. Demographic andnthropometrical data, lab tests, were collected. For each patient,ini Nutritional Assessment (MNA), NRS-2002, a multifrequency

ioimpedentiometrical analysis with Phase Angle and Predictionarker

®(PM – ratio between impedance at 200 kHz and at 5 kHz)

ere performed. PhA < 4.8 was considered a valid cut-off value todentify malnourished patients.

Results: Thirty-eight patients were analyzed. Age was 52 years44–66). 11 (28.9%) patients had normal liver, 4 (10.5%) chronic

epatitis, 1 (2.6%) acute hepatitis, 22 (57.9%) cirrhosis (Child A:1 (28.9%), Child B 8 (21.2%), Child C: 3 (7.9%)). Two patientsere affected by HCC; five patients were admitted for pancreatic

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diseases. Eleven patients were admitted for alcoholic withdrawal.Median PhA was 4.75 (3.80–5.40), PM was 0.845 (0.821–0.874),BMI 23.9 kg/m2 (21.6–27.2). Albumin 29 g/l (25–36), vitamin D11.4 ng/ml (9.1–21.2), zinc 34 �/dl (30–44), vitamin B9 5.9 ng/ml(2.5–11.1), vitamin B12 635 pg/ml (381–1062) were found. Accord-ing to MNA, 29/38 (76.3%) patients were at risk of malnutritionwhereas according to NRS-2002, only 8/38 (21.1%) patients wereat risk. PhA identified 19 (50%) patients affected by malnutri-tion whereas PM > 0.820 identified 26 (68.4%) malnourishedpatients.

Conclusion: Malnutrition in hospitalized patients with alcohol-related diseases is a frequent problem. In clinical practice, MNA isan useful and sensible screening tool and PM is a valid assessmentmethod to identify malnutrition in order to manage nutritionalsupport.

Reference

1] Dasarathy J, McCullough AJ, Dasarathy S. Sarcopenia in alcoholic liver disease:clinical and molecular advances. Alcohol Clin Exp Res 2017 [Epub ahead of print].

http://dx.doi.org/10.1016/j.dld.2017.08.010

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Cardiovascular risk assessment in alcoholicliver disease: A pilot study

M. Porzio ∗, G. Pisano, G. Periti, V. Borroni,S. Pelusi, M. Milano, E. Fatta, C. Bertelli,P. Dongiovanni, A.L. Fracanzani, S. Fargion,L. Valenti

Department of Pathophysiology andTransplantation, Metabolic Liver Diseases,Fondazione IRCCS Ca’ Granda Ospedale Policlinico,Milano, Italy

Chronic alcohol abuse is a leading cause of cirrhosis, but is alsoassociated with increased cardiovascular mortality. However, scantinformation is available on the determinants of atherosclerotic andcardiac disease in individuals with alcohol abuse.

To this end, we considered 36 consecutive subjects with chronicalcohol abuse (>60/40 g/day for at least 5 yrs in M/F, respectively,ALD), who were compared to 36 nonalcoholic fatty liver patientsmatched for age, sex and body mass index. As a reference group,we considered 10 healthy subjects without fatty liver. Cardio-vascular damage was assessed by carotid stiffness by a RF-basedechotracking device, common carotid arteries intima-media thick-ness: CCA-IMT, and presence of carotid plaques, epicardial fatthickness (EFT), and cardiac function (E/A index and ejection frac-tion).

We found that carotid stiffness and CCA-IMT did not differbetween ALD and NAFLD patients (8.8 ± 2.7 vs. 8.9 ± 2.2 m/s; p = NS;IMT 0.8 ± 0.2 vs. 0.8 ± 0.2 mm; p = NS, respectively), although theywere higher than in controls. The prevalence of plaques was higherin ALD than in NAFLD patients (55% vs. 31%; p = 0.04) and controls(10%; p = 0.03). Cardiac diastolic dysfunction, defined by E/A < 1,was more prevalent in ALD than in NAFLD patients (83% vs. 50%,p = 0.003) and controls (20%; p < 0.0001). EFT was also thicker inALD than in NAFLD patients.

Cirrhosis was more prevalent in ALD than in NAFLD patients(46% vs. 6%; p < 0.001) and was associated with thicker EFT anddecreased E/A ratio. At multivariate logistic regression analysis,

chronic alcohol abuse was associated with carotid plaques (OR:4.8, 1.4–18.8; p = 0.01), EFT (estimate 1.8 ± 0.4; p < 0.001) and dia-stolic dysfunction (OR: 5.6, 1.2–33.8; p < 0.001), independently ofconfounders (age, smoke, arterial hypertension, diabetes).

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tion and LT overtime, while AAH represents an increasing indicationin selected patients.

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These data suggest that chronic alcohol abuse is associatedith development of carotid plaques, epicardial fat accumulation

nd cardiac diastolic dysfunction independently of metabolic con-ounders and cirrhosis.

ttp://dx.doi.org/10.1016/j.dld.2017.08.011

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eep transcranial magnetic stimulation of theorsolateral prefrontal cortex in alcohol useisorder patients: Effects on dopamineransporter availability and alcohol intake

. Antonelli 1,∗, L. Sestito 1, G.A. Vassallo 1,

.M. Rando 1, C. Tarli 1, C. Mosoni 1,. Mirijello 1,2, A. Ferulli 1,4, D. Di Giuda 3,. Diana 5, A. Giordano 3, A. Gasbarrini 1,. Addolorato 1

Department of Internal Medicine, Gastroenterologynd Hepatology, Catholic University of the Sacredeart, Rome, ItalyDepartment of Medical Sciences, IRCCS Casaollievo della Sofferenza Hospital, San Giovanniotondo, ItalyInstitute of Nuclear Medicine, Catholic University of

he Sacred Heart, Rome, ItalyDepartment of Endocrinology and Metabolicisease, IRCCS Policlinico San Donato, San Donatoilanese, Milan, ItalyDepartment of Chemistry and Pharmacy,niversity of Sassari, Italy

Repetitive Transcranial Magnetic Stimulation (rTMS) of the dor-olateral prefrontal cortex may affect neuro-adaptations associatedith alcohol use disorder (AUD), potentially influencing craving

nd alcohol intake. We investigated alcohol intake and dopamineransporter (DAT) availability by Single Photon Emission Computedomography (SPECT) in the striatum of AUD patients before andfter deep rTMS. Fourteen patients underwent baseline clinical andPECT assessment. Eleven out of fourteen patients were random-zed into two groups for the REAL (n. 5) or SHAM (n. 6) treatment.linical and SPECT evaluations were then carried out after foureeks of rTMS sessions (T1). At baseline, AUD patients showedigher striatal DAT availability than healthy control subjects (HC).atients receiving the REAL stimulation revealed a reduction inAT availability at T1, whereas the SHAM-treated group did not.

n addition, patients receiving the REAL stimulation had a decreasen alcohol intake. The results of this longitudinal pilot study mayuggest a modulatory effect of deep rTMS on dopaminergic termi-als and a potential clinical efficacy in reducing alcohol intake in

UD patients. Further investigations are required to confirm thesereliminary data.

ttp://dx.doi.org/10.1016/j.dld.2017.08.012

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Evolution of liver transplantation for alcoholicliver disease: A single center study

A. Ferrarese 1,∗, G. Germani 1, C. Becchetti 1,A. Zanetto 1, S. Shalaby 1, E. Romandini 1,F.P. Russo 1, M. Senzolo 1, M. Gambato 1,P. Angeli 2, F. D’Amico 3, U. Cillo 3, P. Burra 1

1 Multivisceral Transplant Unit, Department ofSurgery, Oncology and Gastroenterology, PaduaUniversity Hospital, Padua, Italy2 Internal Medicine, Padua University Hospital,Padua, Italy3 Hepatobiliary Surgery and Liver Transplantation,Padua University Hospital, Padua, Italy

Introduction: Alcohol-related liver disease (ALD) is a majorindication for Liver Transplantation (LT), both for decompensateddisease and for hepatocellular carcinoma (HCC). Recently, LT hasbeen considered a therapeutic option for steroid non-responderAcute Alcoholic Hepatitis (AAH).

Aims: To evaluate trajectories of Waiting List (WL) registrationand LT for ALD and for AAH in a single center cohort of adult LTcandidates.

Materials and methods: All adult patients listed for LT at PaduaUniversity Hospital between 2006 and 2016 were prospectivelycollected. For each patient, demographic data, etiology and severityof liver disease were evaluated. Patients were further divided into3 different interval time periods.

Results: A total of 1117 patients with cirrhosis were registered(M/F 865/252, mean age 55.8 ± 9 years). ALD was the second mostcommon indication to LT overtime (255/1117, 22.8%); patients withALD were mostly males (203/255, 79.5%), with a mean age at WLregistration of 57 ± 7.3 years. ALD was associated with a lower rateof isolated indication to LT for HCC (ALD vs non-ALD: 73/255 vs354/862, p = 0.003), whereas in the subgroup with decompensateddisease, MELD score at WL was not different between non-ALDpatients (18.8 ± 5.5 vs 18.7 ± 6.1, p = 0.9). ALD remained a stableindication to WL registration overtime (Era 1 [2006–2009] vs Era 3[2014–2016]: 78/333 vs 76/352, p = 0.6), both for decompensateddisease and for HCC. In the study period, 127/255 (49%) patientsunderwent LT. Rates of transplantation for ALD remained stableovertime (Era 1 [2006–2009] vs Era 3 [2014–2016]: 30/152 vs42/198, p = 0.7), while mortality and delisting after improvementof liver function were 26.2% and 7.8%, respectively. LT for severeAAH accounted for 1.2% of total LT performed in third Era and for8.3% of LT performed for alcohol-related liver disease.

Conclusions: ALD remained a stable indication to WL registra-

http://dx.doi.org/10.1016/j.dld.2017.08.013

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http://dx.doi.org/10.1016/j.dld.2017.08.015

Abstracts / Digestive and Live

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iver transplantation in patients with alcoholiciver disease: A retrospective study

.A. Vassallo 1,∗, C. Tarli 1, M.M. Rando 1,. Mosoni 1, A. Mirijello 2, M. Antonelli 1,. Sestito 1, G. Perotti 3, D. Di Giuda 3, S. Agnes 4,. Grieco 1, A. Gasbarrini 1,. Addolorato 1, Gemelli OLT Group

Department of Internal Medicine, Gastroenterologynd Hepatology, Catholic University of the Sacredeart, Rome, ItalyDepartment of Medical Sciences, IRCCS Casaollievo della Sofferenza Hospital, San Giovanniotondo, ItalyInstitute of Nuclear Medicine, Catholic University of

he Sacred Heart, Rome, ItalyDepartment of Surgery, Transplantation Service,atholic University of the Sacred Heart, Rome, Italy

Introduction: Alcoholic liver disease is the most common liverisease in the Western World. Alcohol abstinence represents theold standard for its treatment. When liver function fails to improven spite of alcohol abstinence, liver transplantation is the treatmentf for end-stage alcoholic liver disease; however, many transplantenters are still reluctant to transplant these group of patientsecause of the risk of alcohol relapse, recurrence of the primary

iver disease and associated post transplant complications.Aim: The aim of this study was to assess survival rate, prevalence

f primary liver disease recurrence, re-transplantation and post-ransplant complications among transplanted patients for alcoholicirrhosis compared with those transplanted for viral cirrhosis andhe associated risk for post-transplant complications.

Materials and methods results: Clinical data of 400 consecu-ive patients transplanted at Gemelli Hospital from January 1995 topril 2016 were retrospectively collected. Among them, only trans-lanted patients for alcoholic and viral cirrhosis were included inhe statistical analysis. Survival rate was evaluated according tohe Kaplan–Meier method. Recurrence was defined as histologicalvidence of primary liver disease. Data on the onset of complica-ion, causes of death and graft failure after liver transplant wereollected. There was no difference regarding survival rate betweenhe two groups. Only patients transplanted for viral cirrhosis pre-ented with primary liver disease recurrence. For post-transplantomplications, there was a higher rate of cancer developing in theransplanted patients for alcoholic cirrhosis. Cancer was the majorause of death in this population. Risk factors associated with thenset of cancer were a high MELD score at the transplant time andmoking after transplantation.

Conclusions: Alcoholic liver disease is a good indication for liverransplantation. Patients transplanted for alcoholic cirrhosis should

e subjected to regular cancer screening and they should be advisedgainst smoking.

ttp://dx.doi.org/10.1016/j.dld.2017.08.014

se 49(3S) (2017) e237–e242 e241

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The impact of a multidisciplinary team onalcohol recidivism and survival after livertransplantation for alcoholic disease

L. Marzi 1,∗, S. Guerzoni 2, M. Vandelli 3,P. Magistri 4, V. Serra 4, A. Borghi 1,V. Bernabucci 1, E. Villa 1, F. Di Benedetto 4,N. De Maria 1

1 U.O. Gastroenterologia, Italy2 U.O. Tossicologia Medica, Italy3 U.O. Psicologia Clinica, Italy4 U.O. Chirurgia Oncologica Epato-Bilio-Pancreaticae Trapianti di Fegato AziendaOspedaliero-Universitaria Policlinico di Modena,Italy

Introduction: Liver transplant (OLT) for patients with alcoholicabuse (AA) remains controversial, due to the risk of alcohol recidi-vism after transplantation, which ranges from 10 to 95%. To achievea long-term post-OLT alcohol abstinence in AA patients, a compre-hensive evaluation of the OLT candidate by a multidisciplinary team(MT), to include also a psychologist, a pharmacologist and a psychi-atrist, is recommended, coupled with a strict follow-up post-OLTinvolving the same clinical team. Therefore, starting from 2014 aMT has been created at our Transplant Center in Modena, and a fullevaluation from MT has been introduced as a requirement in theOLT screening for individuals with AA.

Aim: To evaluate retrospectively, in AA patients evaluated forOLT in a single Transplant Center, the impact of the MT involvementon alcohol recidivism and survival after transplantation.

Materials and methods – results: All individuals with AA trans-planted at the Liver Transplant Center of University of Modenabetween November 2000 and December 2016 were considered inthe study. 95 individuals with AA were transplanted; 71 patientsdid not undergo an evaluation by the MT (group A) while 24received a full evaluation (group B). Recurrence rate at 3 yrs was18.2% in group A and 16.7% in group B (p = ns); overall survival ratea 3 yrs was 71% in group A and 87% in group B (p < 0.05).

Conclusions: In our experience, the involvement of a multidis-ciplinary team for the evaluation of OLT candidates with history ofalcoholism does not reduce the rate of recidivism after OLT but hasa beneficial effect on overall survival; this might be probably due

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242 Abstracts / Digestive and Live

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s the multidisciplinary support effective inreventing alcohol relapse after liverransplantation?

. Lattanzi 1,∗, M.L. Attilia 2, V. Di Gregorio 1,. D’Ambrosio 1, R. Ledda 2, A. Galli 2, C. Rotondo 2,. Mennini 3, E. Poli 1, F. Attilia 2,. Ginanni Corradini 1, M. Rossi 3, M. Merli 1

Gastroenterology, Department of Clinical Medicine,a Sapienza University of Rome, ItalyAlcohol Dependence Unit, Department of Clinicaledicine, La Sapienza University of Rome, ItalyDepartment of General Surgery and Organransplantation, La Sapienza University of Rome,taly

Introduction: Alcoholic liver disease (ALD) is one of the mainndications for liver transplantation (LT) reaching about 30% inurope and the United States. One of the most important burden inatients transplanted for ALD is alcohol relapse. In fact, accordingo the literature, the 20–50% of patients experience alcohol relapsen the first 5 years after LT. With this in mind, a program of program

f multidisciplinary support to alcohol misuse (MSAM) was startedp at the Transplant Unit of University of Rome “Sapienza” in 2004

nvolving a team of alcohol disorder specialists to help patientsndergoing LD for ALD to cope with their alcohol use disorder.

se 49(3S) (2017) e237–e242

Aim: We aimed at analyze the relapse rate, risk factors forrelapse and survival in patients involved in MSAM. The relapse ratewas also compared with that of a historical group of transplantedpatients.

Material and methods: Consecutive patients with ALDtransplanted from 2004 were included. The most important demo-graphic, psychosocial and clinical characteristics known to beassociated with alcohol relapse were registered. Patients trans-planted for ALD before from 2000 to 2004, with no access to MSAM,were considered as historical control group.

Results: Sixty-nine patients underwent MSAM. 8.7% pre-sented alcohol relapse. Relapse risk factors were female gender(p = 0.004), history of alcohol-withdrawal-syndrome (p = 0.01), ashort follow-up before LT (p = 0.004), few sessions for supportto alcohol misuse (p = 0.003) and a short time of abstinencebefore LT (p = 0.0007). The alcohol relapse rate was significantlylower in the MSAM group vs the historical group (8.7% vs 27.7%;p = 0.02) despite similar demographic, clinical and psychologi-cal characteristics and a similar transplant follow-up protocol.Five-year survival was higher than that of the historical group(p = 0.008).

Conclusion: This study shows that a MSAM program contributes

ALD.

http://dx.doi.org/10.1016/j.dld.2017.08.016