Coffee Consumption Associated With Reduced Risk of Autoimmune Liver Disease

20 May 2013 --- Research presented at Digestive Disease Week (DDW) explores new discoveries in liver disease research, with findings about the impact of coffee on autoimmune disease and palliative care for cirrhotic patients.

While coffee consumption recently has been associated with reduced risk of fibrosis, a new study found that even a few more cups of java each month also correlate with lower risk for a particular autoimmune liver disease. Researchers at the Mayo Clinic, Rochester, MN, linked coffee consumption with reduced risk of primary sclerosing cholangitis (PSC), a disease of the bile ducts that causes inflammation and subsequent duct obstruction that ultimately can lead to cirrhosis of the liver, liver failure and biliary cancer.

"While rare, PSC has extremely detrimental effects," said Craig Lammert, MD, instructor of medicine at Mayo Clinic. "We are always looking for ways to mitigate risk, and our first-time finding points to a novel environmental effect that might also help us to determine the cause of this and other devastating autoimmune diseases."

Funded by grants from the National Institutes of Health and the American Liver Foundation, the study examined the largest cohort of patients with PSC and primary biliary cirrhosis (PBC) in the U.S. as well as a healthy control group. Data showed that coffee consumption was associated with reduced risk of PSC, but not PBC. PSC patients were much more likely to never consume coffee compared with the control group. The control group also spent nearly 20 percent more of their life regularly drinking coffee.

Study highlights need of terminally ill cirrhotic patients

Other DDW research illuminates the need for better palliative care for terminally ill cirrhotic patients who are rejected for a liver transplant. A retrospective cohort review of patients previously assessed or listed for liver transplant by the University of Alberta in Canada found that only 3 percent of patients in the study died while in hospice, a hallmark of palliative care.

"In our study, less than 10 percent of patients had even been referred to palliative care," said Constantine Karvellas, assistant professor of medicine at the University of Alberta. "We need to be better about ensuring quality of life for these patients."

Palliative care is specialized medical care for people with serious, often terminal, illnesses. Its goal is to improve patients' quality of life by concentrating on relief from symptoms, pain and stress.

The patients in Dr. Karvellas's study had been de-listed or declined for liver transplantation. The most common reason was noncompliance with restrictions on substance use, but other reasons related to cancer and multiple organ dysfunction. Researchers examined patients' medical trajectory and the symptoms prominent at their end of life and found that more than half had pain and nausea. Others had symptoms of depression, anxiety, breathlessness and anorexia. Eighty percent required repeat hospital admissions and invasive procedures such as paracentesis, in which fluid accumulation is drained from the abdomen.

"Palliative care offers a way to avoid some of these costly procedures and at the same time improve the quality of life for these patients. These data help to start the conversation on how we can make a positive difference in the lives of many patients and families," Dr. Karvellas said.