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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