Study of correlation of cage questionnaire with gamma glutamyl transferase, mean corpuscular volume and asparate aminotransferase in chronic alcoholism and alcohol liver disease.
ABSTRACT: Objectives :- To study the comparison of the CAGE questionnaire with biological markers (GGT, MCV and AST) in chronic alcoholism and alcoholic liver disease. Design :- Case-control study comparing 50 patients of alcoholic liver disease with 50 patients from non alcoholic liver disease,...
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| Language: | English |
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c2002.
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| Summary: | ABSTRACT: Objectives :- To study the comparison of the CAGE questionnaire with biological markers (GGT, MCV and AST) in chronic alcoholism and alcoholic liver disease. Design :- Case-control study comparing 50 patients of alcoholic liver disease with 50 patients from non alcoholic liver disease, admitted either to Bir Hospital, Tribhuvan University Teaching Hospital or Kathmandu Hospital. Settings :- Patients of alcoholic liver disease and non alcoholic liver disease admitted in the above mentioned hospital. Subject :- Fifty patients (subjects) of alcoholic liver disease and fifty patients suffering from non alcoholic liver disease) were enrolled in this study. Methods :- Fifty patients each in two groups (with alcoholic liver disease and non alcoholic liver disease ) were included in this study per inclusion and exclusion criteria. They were interviewed and examined with the help of semi structured CAGE questionnaire, ( C-have you felt need to cut down drinking ?, A- have you ever felt annoyed by criticism of drinking ?, G- have you had guilty feeling about drinking ?, E- do you ever take morning eye opener ) history related to alcoholism, stigmata of chronic alcoholic liver disease, relevant reports of investigation reports were recorded ( AST, GGT, MCV, ALT, PT, AP). UGI Endoscopy and USG of abdomen findings were analyzed. Results In alcoholic patients group had melena and jaundice are the commonest complaint while non alcoholic group had jaundice as the most common symptoms. Similarly, on physical examination, commonest finding was jaundice (90%) in alcoholic group and hepatomegaly in non alcoholic group. CAGE questionnaire was found to be a very specific and sensitive instrument in diagnosis of chronic alcoholism with sensitivity and specificity of 84% and 96% respectively, when only two affirmative responses were taken for diagnosis. Among biochemical markers, GGT was most sensitive (86% sensitivity) while MCV was the most specific markers with specificity of 80%. The alcoholic group has a mean serum GGT of 161.74 (range 7 to 680, SD 130.01) ; the control group had mean of 28.14 i.u. (range 16 to 110, SD 13.13). There was significant positive correlation between GGT and ALD (p<0.00001). However there was no correlation between GGT level and age of patients. Liver disease group had a mean of 92.66 cubic micrometers (normal value 76 to 96 in cubic micrometers) range 70 to 111.10, SD 14.33 and control groups a mean 84.34 (range 55 to 92, SD 10.99). MCV correlated significantly ( P< 0.0015) with alcoholic liver disease. The values of MCV were higher in older patients and lower for younger ones in alcoholic liver disease group while there were no such type of difference in control group. The mean value of ALT in group I had 45.62+- SD 27.10 while 51.00+- SD 30.95 in group II. ALT levels did not correlate with ALD group (P>0.15. The value of ALT is more than AST in 44% patients in control group while only in 60% in alcoholic liver disease group. The most sensitive diagnostic marker was the GGT (94%) where the most specific marker was MCV (91.1%) however the ssensitivity of AST and MCV was 79.5% and 38.6% respectively, combined sensitivity and specificity of GGT and AST were 83% and 61.9%, the combined sensitivity of GGT and MCV was 50% and combines specificity was 60% in relation to CAGE questionnaire. Oesophageal varices was the commonest findings. 38 Patients (76%) in alcoholic group and 14 patients (28%) in control group were found to have oesophageal varies. Peptic ulcer disease was the second most commonest findings in both groups. 10 patients (20%) in alcoholic group while 6 patients (12%) in control group were found to have peptic ulcer disease. Out of 10, 5 patients (10%) had duodenal ulcer, 5 patients (6%) had gastric ulcer in control group. It was followed by erosive gastritis, 10% gastritis, 6% dudenitis, 6% oesophagitis, 4% in alcoholic liver disease group while gastritis 8%, erosive gastritis 6%, oesophagitis 2% in control group. Liver biopsy could be performed in only 10 patients, Presence of major contraindication to liver biopsy, (like prolonged prothrombin time, gross ascities, small fibrtic liver and hepatocellular failure) and refusal by the patients. Out of 10, liver biopsies, 9 were carried in control group and one patients in alcoholic liver disease group. The most common findings of liver biopsy is chronic persistent hepatitis in 6 HBsAg (antigen) or anti HCV antibodies positive patients, followed by mild non specific inflammatory changes in 2 patients with history of HBsAg or anti HCV positive while one patients had history of ingestion of alcohol more than 120 gram /day over 15-20 years with answering more than two of the CAGE questions affirmatively found to be cirrhosis of liver in liver biopsy. Conclusion : - The results of this study showed that the CAGE questionnaire is more effective than laboratory measurements in screening for alcoholism, however objective variables are irreplaceable when facing defensive or uncooperative patients. - GGT proves to be the best marker of alcohol abuse and alcoholic liver disease. It helps objective detection for therapeutic action to be initiated early. - This study also confirms that GGT, MCV, AST are effective markers for detecting alcoholism. The two important factors influencing GGT are the duration of abstinence before blood testing and quality of alcohol consumed. If limitation of each markers are understood and taken into consideration, biological markers, especially used in combinations, are useful aids in diagnosis of alcoholism and alcoholic liver disease. - Identification of problem drinking can improve by the use of brief screening instrument like CAGE questionnaire and this strategy has been found to be useful in early detection and management of alcohol abuse health problems in this part of the world. - This study concludes that the CAGE questionnaire has a higher correlation with a combination of biological alcohol markers and that the CAGE may be the questionnaire of choice for identification of alcohol problems. - The parameter singly or in combination is diagnostic although suggestive, while CAGE questionnaire in combination of biological parameters is highly suggestive of alcoholic liver disease in 96%. |
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| Item Description: | Thesis Report. |
| Physical Description: | vii, 117p. : |