Highlighting Gender-based Differences in Alcohol-associated Hepatitis

During her Yale School of Medicine (YSM) fellowships in gastroenterology and transplant hepatology, Anahita Rabiee, MD, MHS, instructor of medicine (digestive diseases), saw a lot of men and women admitted with alcohol-associated hepatitis—the most severe form of alcohol-related liver disease—at Yale New Haven Hospital. At the time, she couldn’t help noticing that women with this condition tended to have worse outcomes than men.

“It seemed that women with alcohol-associated hepatitis showed symptoms later in the course of the disease than men did and had a higher mortality rate,” said Rabiee, who came to YSM as a resident in 2015.

For her new research project, supported by a Small Award Initiative for Impact from the U.S. Department of Veterans Affairs (VA) Center of Innovation for Pain Research, Informatics, Multimorbidities, and Education, Rabiee plans to find out if there is data to support her observations during fellowship. She will examine gender-based differences in presentation and outcomes among veterans with alcohol-associated hepatitis using data from VA medical centers across the U.S.

Women and men process alcohol differently, Rabiee explains, and women are at risk for developing alcohol-related liver disease with less alcohol consumption as compared with men. “Women are very vulnerable to the effects of alcohol from a liver disease standpoint,” she said.

Studies show that alcohol-use disorder is more common among veterans than civilians, Rabiee notes, adding that some veterans try to cope with PTSD, depression, anxiety, and other mental health conditions by using drugs or alcohol. Women veterans might be less likely to seek care for substance-use disorders because of the associated stigma and the predominantly male environment of the VA, she says.

There are few warning signs for alcohol-associated hepatitis, according to Rabiee. “An individual might be feeling fine, then suddenly present with ascites—in which fluid builds up in the abdomen—or jaundice, in which the skin or whites of the eyes can turn yellow because of a high level of bilirubin,” she said. “It’s important to diagnose and treat alcohol-use disorder before patients get to the final stage of alcohol-associated hepatitis, which in severe cases, has very high mortality without a liver transplant.”

Through her research, Rabiee hopes to find patterns in men and women veterans who are at risk for alcohol-associated hepatitis. “Specifically, I’d like to come up with an algorithm using VA electronic health records to identify women veterans who are at high risk for development of alcohol-related liver disease,” she said. For example, Rabiee says, a woman veteran who has had weight loss surgery could be considered high risk for alcohol-related liver disease because the procedure changes the way the body metabolizes alcohol.

This is Rabiee’s first funded research project. She is working with a team of researchers and mentors, including Tamar Taddei, MD, professor of medicine (digestive diseases), Kathleen Akgün, MD, MS, associate professor of medicine (pulmonary, critical care and sleep medicine), and Lori Bastian, MD, MPH, professor of medicine (general medicine).

Since forming one of the nation’s first sections of hepatology and then gastroenterology over 50 years ago, Yale’s Section of Digestive Diseases has had an enduring impact on research and clinical care in gastrointestinal and liver disorders. To learn more, visit Digestive Diseases.