En el Día Mundial Sin Alcohol, la Fundación Española del Aparato Digestivo (FEAD) quiere recordar las nocivas consecuencias que el consumo elevado y prolongado de alcohol tiene para la salud en general y para el hígado en particular, y en especial alertar sobre los peligros del consumo social del alcohol muy especialmente entre los jóvenes.
“El alcohol produce en el hígado lo que llamamos hepatopatía alcohólica, que es un espectro de lesiones que se agrupan en tres síndromes fundamentalmente y que además son evolutivos en gravedad y dificultad de tratamiento: la esteatosis hepática alcohólica o hígado graso por alcohol en fase inicial, y la hepatitis alcohólica y la cirrosis hepática alcohólica, que son etapas más graves de la misma enfermedad” explica el Dr. José Miguel Rosales Zábal, especialista del aparato digestivo y portavoz de la Fundación Española del Aparato Digestivo (FEAD). Además, la cirrosis hepática puede facilitar el desarrollo de cáncer de hígado.
En España se estima que el alcohol es el responsable del 40-50% de los casos de cirrosis hepática, siendo así la principal causa de cirrosis. En cuanto al cáncer de hígado, entre un 20- 50% de los cánceres de hígado que se someten a trasplante hepático son debidos al alcohol. La gravedad y dificultad del tratamiento de las hepatopatías viene demostrado por las bajas cifras de supervivencia a largo plazo. Solo sobreviven más de cinco años el 58% de los pacientes con hepatopatía alcohólica, el 49% de pacientes con cirrosis provocada por el consumo de alcohol y el 33% de pacientes con hepatitis alcohólica sobre una cirrosis previa.
“Los efectos nocivos del alcohol sobre el hígado vienen definidos por múltiples factores, por un lado, relacionados por los efectos sobre el propio órgano y su metabolismo, y, por otro lado, relacionados con la propia susceptibilidad de cada persona, pues los daños no son iguales en todos”, añade el Dr. Rosales Zábal.
Los efectos del alcohol en el hígado
El 90% del alcohol que absorbe el organismo se metaboliza en el hígado a través de unas células llamadas hepatocitos en las que el alcohol se “oxida” transformándose en acetaldehído, una sustancia que es considerada la principal responsable de los efectos nocivos del alcohol. El acetaldehído es capaz de estimular el sistema inmune y activar sustancias inflamatorias que dañan las células del hígado, degenerándolas y produciendo su destrucción. Además puede provocar fibrosis, es decir, la sustitución de tejido sano del hígado por un tejido “cicatricial” que no puede cumplir con las funciones de un hígado sano. El acetaldehído también estimula los procesos que generan cáncer. La oxidación del alcohol en el hígado favorece una serie de mecanismos que aumentan el depósito de grasa y la aparición de hígado graso.
La susceptibilidad individual no se conoce con exactitud, pero hay varios factores que influyen en aumentar el riesgo de desarrollar hepatopatía alcohólica: la edad (es más frecuente entre los 40 y 50 años), el sexo (las mujeres son más susceptibles), la raza (es más común en americanos, africanos e hispanos), el consumo de tabaco, la obesidad, el tipo de bebida y la forma de consumirla, factores genéticos, o el consumo de alcohol con medicamentos que puedan potenciar su efecto dañino y que son tan habituales como el paracetamol.
La gravedad y alta mortalidad de las enfermedades hepáticas refleja la necesidad de un diagnostico precoz y de iniciar de forma temprana los tratamientos apropiados. Sin embargo, tal como recuerda el Dr. Rosales Zábal “la abstinencia al alcohol es el mejor tratamiento, si no se consigue, los tratamientos serán poco efectivos y lo más importante, puede dificultar la realización de otros tratamientos como el trasplante hepático”.
En la fase más inicial del daño hepático, cuando se trata de hígado graso o hepatitis leve, el abandono del alcohol evita la progresión del daño e incluso puede revertirse. Las hepatitis agudas por el alcohol necesitan hospitalización, tratamiento nutricional y a veces con corticoides. Sin embargo, en fases avanzadas, con cirrosis, el daño es irreversible. En estos casos, el abandono del alcohol disminuye, aunque no lo suprime, el riesgo de poder desarrollar un cáncer de hígado o bien otras complicaciones de la cirrosis, como la aparición de líquido en el abdomen (ascitis), hemorragias digestivas, encefalopatía hepática (alteraciones del comportamiento y del nivel de conciencia), etc. El trasplante hepático es una opción en situaciones de muy mala función hepática y siempre que la persona no beba nada de alcohol desde hace más de 6 meses.
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