Systemic & Metabolic Changes Observed in Alcohol Dependent Male Patients After Alcohol Withdrawal

Alcohol abuse is associated with psycho-somatic health and social problems. It leads to multi-organ, especially cardiovascular system, alimentary tract, liver, pancreas and immunologic system dysfunction. Therefore withdrawal and anti-relapse therapy should be undoubtedly undertaken in every case. Nevertheless our knowledge about alcohol withdrawal consequences is insufficient. The main purpose of the authors'' investigation was to determine the metabolic, endocrine, haemostatic and immunologic changes during six-month long abstinence period. They studied the abstinence effect on exercise capacity and autonomic nervous system activity estimated by heart rate variability analysis. Their research concerned also changes in upper digestive tract macroscopic and microscopic appearance and its motility, liver function, pro- anti- oxidative balance parameters level, cytokine TNF- alpha and nitric oxide (NO) metabolites plasma concentration. The authors estimated inter-relationships between studied parameters, what seems to be very important in complete analysis. Within six-months long abstinence period pro-atherogenic metabolic changes expressed by decreased HDL and increased LDL- cholesterol plasma concentration occurred. These unfavourable changes were less expressed in patients treated with naltrexone. In the early abstinence period indirect markers of platelets activation were determined. The highest level of fibrinogen, thrombomodulin, antithrombin, markers of trombinogenesis activation in vivo (thrombin- antithrombin, TAT complexes), tissue type plasminogen activator antigen (t-PA:Ag), antigen of plasminogen activator inhibitor type 1 (PAI-1:Ag), markers of fibrinolysis activation in vivo, such as D-dimers, plasmin- alpha2- antiplasmin (PAP) complexes was also observed. Mentioned changes were expressed in patients with determinable TNF-alpha plasma level. Abstinence improved effort capacity, positively changed autonomic nervous system activity via vagal nerve influence on heart rate variability. The last finding was also affected by TNF-alpha level. No significant changes appeared in alimentary tract function, estimated by esophageal and gastric pH-metry, esophageal manometry and abdominal ultrasonography, whereas some changes were observed in endoscopic examinations and influence of patients mental status on investigated parameters became noticeable. Favourable effect on liver function tests was affected by pituitary-thyroid and pituitary-gonadal axes hormones, cytokine TNF-alpha, nutrition status, Helicobacter pylori infection and gastric acidity. Some of studied parameters, such as mean platelets volume and nitric oxide metabolites plasma level may be used as new, valuable markers of alcohol abuse. Alcohol withdrawal and early abstinence is a dynamic period with potentially harmful health consequences, especially in cardiovascular system. This suggests the need of multicentre studies to estimate clinical importance of found changes and cost- benefits analysis of selected interventions.