ALCOHOL DEPENDENCE IN GASTROENTEROLOGY OUTPATIENT ON A PUBLIC HOSPITAL

ABSTRACT BACKGROUND: Alcoholism and alcoholic liver disease are both considered worldwide health problems. OBJECTIVE: The prevalence of alcohol dependence, the associated risk factors and the concordance between the prevalence found and the data collected during the medical visit were evaluated. METHODS: A prospective study evaluating gastroenterology outpatients at a public tertiary hospital was conducted. Two specific questionnaires to assess alcohol dependence were applied: Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE) and The Alcohol Use Disorder Identification Test (AUDIT). Data on comorbidities, clinical diagnosis and assessment of alcohol consumption by the attending physician were collected through medical records. RESULTS: One hundred and seventy eight patients were interviewed, of which 119 (66.9%) were women and 59 (33.1%) were men, with mean age of 57 years. Thirty-three (18.5%) of the 178 patients were considered alcohol-dependent by the CAGE questionnaire. Thirteen (7.3%) patients scored 8 points or more on the AUDIT questionnaire. The agreement (kappa) between these questionnaires was 0.37 (P<0.001). The most consumed drink was beer. The median daily consumption of dependent patients was 64 g. None of the patients were undergoing treatment in a specific treatment center, and 14/33 (42.4%) patients considered themselves alcoholics. Only in 17/33 (51.5%) there was information about alcoholism in their respective medical records. In the bivariate analysis, male gender (P<0.001), onset of alcohol consumption before the age of 15 (P=0.003), daily alcohol consumption in the last 12 months (P<0.001) and smoking (P<0.001) were identified as risk factors. After multivariate analysis, only male gender (P=0.009) and smoking (P=0.001) were associated with alcoholism. CONCLUSION: The present study demonstrated a high prevalence of alcohol dependence in the gastroenterology outpatient clinic, being predominantly associated with male gender and smoking. It is worth noting that approximately half of the dependents were not identified as such in the medical appointment, evidencing the importance of the diagnostic approach in the alcoholic outpatient.

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RESUMO CONTEXTO: O alcoolismo e a doença hepática alcoólica são considerados problemas de saúde de relevância mundial. OBJETIVO: Avaliar a prevalência de dependência alcoólica, os fatores de risco associados e a concordância entre a prevalência encontrada e os dados coletados na consulta médica. MÉTODOS: Estudo prospectivo, avaliando pacientes de ambulatório de gastroenterologia de um hospital terciário, composto por um questionário geral e dois específicos para avaliar a dependência de álcool: Cut down, Annoyed by criticism, Guilty, Eye-openner (CAGE) e o Alcohol Use Disorder Identification Test (AUDIT). Dados sobre comorbidades, diagnóstico clínico e aferição sobre o consumo de álcool pelo médico assistente, foram coletados através de revisão de prontuário. RESULTADOS: Foram entrevistados 178 pacientes, 119 (66,9%) mulheres e 59 (33,1%) homens com média de idade de 57 anos. Trinta e três (18,5%) dos 178 pacientes foram considerados dependentes alcoólicos pelo questionário CAGE. Treze (7,3%) pacientes fizeram oito ou mais pontos no questionário AUDIT. A concordância (kappa) entre os testes foi 0,37 (P<0,001). A bebida mais consumida foi a cerveja. A mediana de consumo diário dos pacientes dependentes foi de 64 g, nenhum destes estava em tratamento em centro específico, 14/33 (42,4%) pacientes seconsideravam alcoolistas e em apenas 17/33 (51,5%) havia registro no prontuário sobre alcoolismo. Na análise bivariada, gênero masculino (P<0,001), início de consumo de álcool antes dos 15 anos (P=0,003), consumo diário de bebida alcoólica nos últimos 12 meses (P<0,001) e tabagismo (P<0,001) foram identificados como fatores de risco. Após análise multivariada, permaneceram associados: gênero masculino (P=0,009) e tabagismo (P=0,001). CONCLUSÃO: O presente estudo demonstrou alta prevalência de dependência alcoólica no ambulatório geral de gastroenterologia, estando associada predominantemente ao gênero masculino e ao tabagismo. Ressalta-se que aproximadamente metade dos dependentes não foram identificados como tal na consulta médica, evidenciando a importância da abordagem diagnóstica no paciente alcoolista.

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