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Prevention and treatment of alcoholic liver diseases

(Inter)national conference for health professionals

Utrecht, November 21, 2013.

Background

The liver is very susceptible to the toxic effects of alcohol. Alcohol use can cause fatty liver,

liver inflammation, liver cirrhosis and increase the risk for liver cancer. Still, there is

remarkably little public awareness for this severe damage caused by alcohol. Therefore, it is

important to spread and share the knowledge and experience present in the Netherlands

with regard to treatment and care for people with these severe symptoms. And exactly this is

the aim of this conference: present, share and discuss the knowledge and experiences of

scientists, specialists and other health professionals.

Thus, the conference “Prevention and treatment of alcoholic liver diseases” intends to

communicate the complexity of alcohol and the liver, taking into account the new knowledge

and recent practice experiences. After you have attended the conference, you know more

about how to recognize, discuss, treat and prevent!

Key questions that will be addressed are:

- How does alcohol affect the liver; what are the mechanisms of alcoholic liver diseases?

- How extensive is the problem of alcoholic liver diseases in Europe and especially in the

Netherlands?

- How can doctors recognize problematic alcohol use? What is the role of general

practitioners?

- In what way can general hospitals and addiction institutes cooperate effectively?

- What are the main interventions for alcohol dependence? Are these interventions

effective?

- How is the current infrastructure in general hospitals for patients with an alcoholic

liver disease?

- Can alcohol clinics for adults be organized to improve this infrastructure?

Location: Domstad Utrecht

Chairman: Prof. Dr. Martijn Katan (Professor Emeritus Nutrition, VU University Amsterdam)

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Program:

Plenary morning session (9:30 – 12:45): The liver and our health

9:30 – 9:45: Prof. Dr. Martijn Katan: Welcome

9:45 – 10:00: Prof. Dr. Peter Anderson: Alcohol and public health

10:00 – 10:25: Dr. Nick Sheron: Alcoholic liver diseases: Trends in the UK and Europe

10:25 – 10:50: Prof. Dr. Mark Thursz: Clinical management and EASL policy work

Break: 10:50 – 11:15

11:15 – 11:45: Prof. Dr. Peter Jansen: 'Alcohol, fuel to the fire of metabolism’

11:45 – 12:15: Prof. Dr. Wim van den Brink: Alcohol dependence

12:15 – 12:45: Dr. Rob de Man: The role of liver transplantation in the treatment of post

alcoholic liver cirrhosis

Lunch break 12:45 – 14:00

Afternoon sessions (14:00 – 15:15)

Session A. Early detection of liver diseases

14:00 – 14:40: Martijn Sijbom MSc. (general practitioner): Current and future practices of

Dutch general practitioners regarding early detection

14:40 – 15:15: Dr. Nick Sheron: Southampton Traffic Light Test: Effective early detection

Sessie B. Motivation to treatment

14:00 – 14:40: Prof. Dr. Gerard Schippers: How to speak to patients with an alcohol problem:

the principles of motivational interviewing

14:40 – 15:15: Dr. Peter Vossenberg (Tactus): The added value of addiction services to the

liver patient

Break 15:15 – 15:45

Plenary closure session (15:45 – 16:30)

15:45 – 16:00: Dr. Nico van der Lely: Are the experiences with alcohol clinics applicable for

the care of liver patients?

16:00 – 16:30: Discussion led by Prof. Dr. Martijn Katan

Closure 16:30 – 17:00

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Speakers:

Plenary morning session (9:30 – 12:45)

9:30 – 9:45: Martijn Kata: Welcome, introduction, discussion with a liver patient

Martijn B. Katan is emeritus professor of

nutrition at VU University in Amsterdam. He is a

member of the Royal Netherlands Academy of

Sciences, and a highly cited scientist. His

research focuses on diet, heart disease and

obesity. Katan is much in demand by the media

and writes a column for the leading Dutch

newspaper, NRC-Handelsblad. He has expressed

concern about the influence of commercial

interests on nutrition science.

Topic: Martijn Katan will welcome participants, give an overview of the conference, discuss

whether moderate alcohol intake is healthy and put questions to Hans Eekman, an alcoholic

liver patient.

9:45 – 10:00: Peter Anderson: Alcohol and public health

Peter Anderson is trained as a general practitioner and

specialist in public health medicine at the University of

Oxford and the London School of Hygiene and Tropical

Medicine. His PhD was on the risk of alcohol and what

general practitioners can do. He is currently a consultant in

addictions policy. He was the regional advisor for both

alcohol and tobacco with the European Office of the World

Health Organization from 1992 to 2000. Since 2001, he has

been working as an independent consultant, and has been

an adviser in the field of addictions to the European

Commission, the World Health Organization (European

Regional Office and Headquarters) and many governments

and governmental bodies around the world. He was the author of a 400 page report for the

European Commission on Alcohol in Europe, translating the evidence base and experience of

alcohol policy and prevention programmes for policy makers, programme implementers and

researchers. Since 2012, Anderson is professor in Substance Use, Policy and Practice at

Newcastle University in the UK and professor in Alcohol and Health at Maastricht University

in the Netherlands.

Topic: Peter Anderson will provide a broad overview of the consequences of alcohol use for

public health in Europe.

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10:00 – 10:25: Nick Sheron: Alcoholic liver diseases: Trends in the UK and Europe

Nick Sheron is an academic, clinical liver

doctor (hepatologist) at the University of

Southampton and is the head of the liver

department of Southampton General

Hospital. He conducts a lot of research on

alcohol-related problems. He is co-founder

of the Alcohol Health Alliance in England,

an umbrella organization comprising 27

different organizations with the aim to

increase the lobby for "evidence-based" policy to reduce the alcohol-related damage in the

UK. He is also a founding member of the European Alcohol and Health Forum, which aims to

advise about alcohol strategies in the EU.

Topic: In his first, plenary presentation, Nick Sheron will give an overview of the topic alcohol

and the liver, will contrast trends in the UK with Europe and will cover the mechanisms for

these changes including the role of the industry.

10:25 – 10:50: Mark Thursz: Clinical management and EASL policy work

Mark Thursz is Professor of Hepatology at the Imperial College

in London. In the UK, he is very active in promoting the

interests of Hepatology as a specialty, and promoting the

interests of his patients. Thursz was the Secretary of the British

Association for Study of the Liver (BASL) and chaired the British

Liver Disease Clinical Interest Group which coordinates

multicentre clinical research in liver disease across the UK.

Thursz was EASL Vice-Secretary from 2009 to 2011 and

Secretary General from 2011 to 2013. In these positions, Thursz

represented EASL in the European Alcohol and Health Forum

(EAHF), a European platform in which he discussed the

challenges ahead to reduce alcohol-related harm. By stressing

that liver disease is the only top 5 killer in Europe to be on the

increase, Thursz aimed to improve policy-makers’ awareness of the importance of alcoholic

liver disease.

Topic: Mark Thursz will talk about the clinical management of alcoholic liver diseases and will

discuss EASL’s influence on European policy makers in order to reduce the number of

alcoholic liver patients.

Break: 10:50 – 11:15

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11:15 – 11:45: Peter Jansen: 'Alcohol, fuel to the fire of metabolism’

Peter Jansen is professor of gastroenterology and hepatology

at the Academic Medical Center in Amsterdam (emeritus

since March 2011) . His area of expertise includes metabolic,

genetic, drug-induced and viral liver disease as well as

hepatocellular carcinoma. Peter Jansen has a long track

record of serving on governing boards of scientific

organizations both in Europe and North America. He is active

in postgraduate teaching and lectured throughout Europe,

the Middle East, China and Australia. He published over 300

papers. He serves on advisory boards of multicenter studies

and is active in advising pharmaceutical companies on the effects of new drugs on the liver.

Topic: Peter Jansen will present the metabolism of alcohol in the human body and how

alcohol (and its metabolites) affects the liver (and also the pancreas). In his presentation, he

illustrates what happens in the body when a person drinks alcoholic beverages.

11:45 – 12:15: Wim van den Brink: Alcohol dependence

Wim van den Brink is professor of Psychiatry and Addiction at the

Academic Medical Center of the University of Amsterdam (AMCUvA)

and Director of the Amsterdam Institute for Addiction Research

(AIAR). His research aims to uncover the neurobiological processes

involved in the development of addictive behaviours and the effects

of neurobiological interventions to prevent relapse in alcohol

dependent patients and pathological gamblers using

neuropsychological tests, neurophysiological procedures and/or

neuroimaging techniques. He chaired the working group that

developed multidisciplinary guidelines for the treatment of alcohol

dependence in The Netherlands. He published over 300 papers and is

editor of European Addiction Research, associate editor of Drug and Alcohol Dependence and

member of the editorial board of Addiction, Addiction Biology, Current Drug Abuse Reviews,

International Journal of Methods in Psychiatric Research, Mind and Brain, and Sucht.

Topic: Wim van den Brink gives a presentation about addiction in general and more

specifically about alcohol dependence. He will present the definition of addiction and which

addiction models exist. Then, he gives an overview of effective treatments of alcohol

dependence. And he will discuss why only 20% of the alcohol dependent patients visit

addiction services and what happens to the other 80%.

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12:15 – 12:45: Rob de Man: The role of liver transplantation in the treatment of post

alcoholic liver cirrhosis

Robert A. de Man is Associate professor of Gastroenterology and

Hepatology at Erasmus MC. His research focuses on the

consequences of decompensated liver disease, liver tumours and

viral hepatitis. De Man is keenly interested in education and

training and responsible for the training program in

gastroenterology at Erasmus MC and chairman of the nationwide

MDL education committee. De Man is also interested in the

organisation of medical care and quality systems in health care.

He is a medical coordinator of the clinical department of

Gastroenterology and Hepatology, subsidiary head of the

department of Gastroenterology and Hepatology, NIAZ auditor,

chairman of the committee in quality audits in Gastroenterology,

member of the internal audit committee Erasmus MC, and

member of the advisory board patient care Erasmus MC.

Topic: Robert De Man will give a presentation about the course of the patient from the

moment he is diagnosed with alcoholic liver cirrhosis to his liver transplantation. Topics that

he will address are spontaneous recovery of decompensated liver disease after alcohol

abstinence indication, selection and timing for liver transplantation as well as the risk of

recurrent alcohol abuse post-liver transplantation.

Lunch break: 12:45 – 14:00

Afternoon sessions (14:00 – 15:15)

Session A. Early detection of liver diseases

14:00 – 14:40: Martijn Sijbom: Experiences of Dutch general practitioners regarding early

detection of problematic alcohol use

Martijn Sijbom has been registered as a general

practitioner since 2009 and is experienced in the general

practice of how to care and screen for patients with

harmful alcohol use. In 2011, he became scientific

employee of the Dutch College of General Practitioners.

At this moment he is working on the revision of the

Practitioners’ Standard of Disorders in the use of alcohol.

Topic: Martijn Sijbom will present the current practices

of Dutch general practitioners (GP’s) with regard to early

detection of harmful alcohol use. What are the

guidelines for GP’s, which tools do they use, how

successful are they with regard to early detection, which symptoms of alcoholic liver

diseases are revealed in the practice, which challenges do GP’s meet when encountering

problematic alcohol use, etc. As Sijbom is working on the revision of the guidelines with

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regard to early detection of problematic alcohol use, he will shortly present the current state

of this revision.

14:40 – 15:15: Nick Sheron: Southampton Traffic Light Test: Effective early detection

CV: See above

Topic: In his presentation in Session A, Nick Sheron will talk about the Southampton Traffic

Light Test. This is an effective early detection test, especially in combination with the AUDIT-

C. Sheron has shown that this test has a great effect on the decrease of alcohol use of

patients, even if their test result is green. Is it feasible to implement the STL in GP practices

in the Netherlands?

Session B. Motivation to treatment

14:00 – 14:40: Gerard Schippers: How to speak to patients with an alcohol problem: the

principles of motivational interviewing

Gerard M. Schippers is emeritus professor of

Addictive Behaviors and Treatment Evaluation at

the Amsterdam Institute for Addiction Research

(AIAR). His main topics were implementation of

evidence based substance abuse treatment,

cognitive behavioral therapy and brief

interventions. He published over 150 articles in

peer reviewed journals. He is chief editor of the

Dutch Journal Verslaving. Schippers has

developed the MATE (Measurements in the

Addictions for triage and evaluation), a tool to

refer patients to substance abuse treatment and

evaluate the provided treatment. In addition, he

is an expert on Motivational Interviewing and one

of the first psychologists who applied this technique in the Netherlands. Schippers is still

working as a psychologist and psychotherapist at a psychologists practice, managed by him

and his wife.

Topic: Gerard Schippers will give an introduction on motivational interviewing. Based on his

experiences with alcohol dependent patients, he will explain how motivational interviewing

can be effective in the treatment of alcohol dependence.

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14:40 – 15:15: Peter Vossenberg: The added value of addiction services to the liver patient

Peter Vossenberg is medical doctor specialized in addiction

medicine and social medicine. Since 1982, he works at an

addiction treatment center, Tactus Verslavingszorg. He

provides both inpatient and outpatient services for alcohol

dependent patients. In addition, he educates students

learning for Master in Addiction Medicine. In addition, he is

chairman of the Dutch Society for Addiction Medicine

(VVGN).

Topic: In his presentation, Peter Vossenberg will articulate the added value of addiction

services for general hospitals dealing with alcohol dependent patients. He will present the

current activities of addiction services: which treatments are available for these patients,

what is the outcome of these treatments and what happens after these patients are being

treated. In addition, Vossenberg will talk about the current cooperation between general

hospitals and addiction services, whether this cooperation can be improved and what the

consequences are of an improved cooperation.

Break: 15:15 – 15:45

Plenary closure session (15:45 – 16:30)

15:45 – 16:00: Nico van der Lely: Are the experiences with alcohol clinics applicable for the

care of liver patients?

Dr. Nico van der Lely is pediatrician at the Reinier de Graaf

Hospital in Delft, where he studies alcohol and youth and

alcohol prevention. The increasing number of cases of

alcohol poisoning was the reason why Van der Lely set up

an outpatient clinic Youth and Alcohol in 2006, together

with child and adolescent psychologist Mireille de Visser.

He believes it is very important that we guard our children

against the dangers of alcohol. Netherlands now has five

alcohol clinics supported by him, in which aftercare plays a

central role. Once a young person recovers from his or her

coma, a team of educators and psychologists is ready to

ensure that repetition is avoided. In addition to his work in

the hospital, he helps municipalities and other parties with

their alcohol projects.

Topic: Nico van der Lely will present his experiences with setting up an outpatient alcohol

clinic. The results of this clinics are presented. These alcohol clinics are a good example of an

improved medical infrastructure for alcohol dependent patients as illustrated by experiences

of his patients.

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16:00 – 16:30: Discussion led by Katan

CV: See above

Topic: Martijn Katan will chair a discussion on the treatment of alcoholic liver patients. What

is the role of the GP, the liver doctor, the addiction therapist, the nurse and the social

worker? How can this infrastructure be improved? Is it feasible to implement the

Southampton Traffic Light Test in the Netherlands? What could outpatient clinics according

to the model of Nico van der Lely contribute to treatment of alcohol-dependent adults?

Closure with drinks and bites 16:30 – 17:00