Alcoholic hepatitis

Alcoholic hepatitis is inflammation of the liver caused by drinking alcohol.

Alcoholic hepatitis is most likely to occur in people who drink heavily over many years. However, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately.

If you’re diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.

Symptoms

The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes (jaundice)

Other signs and symptoms include:

• Loss of appetite
• Nausea and vomiting
• Abdominal tenderness
• Fever, which is often low-grade
• Fatigue and weakness
• Weight loss

Just about everyone who has alcoholic hepatitis is malnourished. Drinking large amounts of alcohol suppresses the appetite, and heavy drinkers get most of their calories in the form of alcohol.

Signs and symptoms of severe alcoholic hepatitis include:

• Fluid accumulation in your abdomen (ascites)
• Confusion and behavior changes due to a buildup of toxins normally broken down and eliminated by the liver
• Kidney and liver failure

When to see a doctor

Alcoholic hepatitis is a serious disease. Up to 30 to 40 percent of people with severe alcoholic hepatitis can die within one month.

See your doctor if:

• You have any signs or symptoms of alcoholic hepatitis
• You feel you can’t control your drinking
• You would like help to cut back on your drinking

Causes

Alcoholic hepatitis develops when the alcohol that you drink damages your liver. Just how alcohol damages the liver — and why it does so only in some heavy drinkers — isn’t clear.

It is known that:

• The body’s process for breaking down alcohol produces highly toxic chemicals
• These chemicals trigger inflammation that destroys liver cells
• Over time, scars replace healthy liver tissue, interfering with liver function
• This irreversible scarring (cirrhosis) is the final stage of alcoholic liver disease

Other factors that can contribute to alcoholic hepatitis include:

• Other types of hepatitis. If you have hepatitis C and also drink — even moderately — you’re more likely to develop cirrhosis than if you don’t drink.
• Malnutrition. Many people who drink heavily are malnourished, because they eat poorly or because alcohol and its byproducts prevent the body from properly absorbing nutrients. Lack of nutrients contributes to liver cell damage.

Risk factors

The major risk factor for alcoholic hepatitis is the amount of alcohol you consume. The amount of alcohol intake that puts a person at risk of alcoholic hepatitis isn’t known. But most people with the condition have a history of drinking more than 3.4 ounces (100 grams) — equivalent to seven glasses of wine, seven beers or seven shots of spirits — daily for at least 20 years.

Other risk factors include:

• Your sex. Women seem to have a higher risk of developing alcoholic hepatitis possibly because of differences in the way alcohol is processed in women.
• Obesity. Heavy drinkers who are overweight might be likelier to develop alcoholic hepatitis and to progress from that condition to cirrhosis.
• Genetic factors. Studies suggest there may be a genetic component in alcohol-induced liver disease although it’s difficult to separate genetic and environmental factors.
• Race and ethnicity. Although it’s difficult o separate genetic and environmental factors, African-Americans and Hispanics might be at higher risk of alcoholic hepatitis.
• Binge drinking. Consuming five or more drinks at one time might increase your risk of alcoholic hepatitis.

Complications

Complications of alcoholic hepatitis include:

• High blood pressure in the liver. Scar tissue can slow the flow of blood through your liver, causing an increase in pressure in a major blood vessel (portal vein).
• Enlarged veins (varices). Blood that can’t flow freely through the portal vein can back up into other blood vessels in the stomach and esophagus. These blood vessels have thin walls and are likely to bleed if filled with too much blood. Heavy bleeding in the upper stomach or esophagus is life-threatening and requires immediate medical care.
• Ascites. Fluid that accumulates in the abdomen might become infected and require treatment with antibiotics. Ascites aren’t life-threatening but are usually a sign of advanced alcoholic hepatitis or cirrhosis.
• Jaundice. A damaged liver can’t remove the residue of old red blood cells (bilirubin) from your blood. Bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.
• Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The buildup of toxins can damage your brain. Severe hepatic encephalopathy can result in coma.
• Cirrhosis. This irreversible scarring of the liver frequently leads to liver failure.
• Kidney failure. A damaged liver can affect blood flow to the kidneys, resulting in damage to those organs.

Diagnosis

Your doctor will conduct a physical examination and ask about your history of alcohol consumption. It is important to be honest in describing your drinking habits. Your doctor might ask to interview family members about your drinking.

To test for liver disease, your doctor might recommend:

• Liver function tests
• Blood tests
• An ultrasound, CT or MRI scan of the liver
• A liver biopsy, if other tests and imaging don’t provide a clear diagnosis or if you are at risk of other causes of hepatitis

Treatment

Treatment for alcoholic hepatitis involves drinking cessation and therapies to ease the signs and symptoms of liver damage.

Drinking cessation

If you’ve been diagnosed with alcoholic hepatitis, you must stop drinking alcohol and never drink alcohol again. It’s the only way of possibly reversing liver damage or preventing the disease from becoming worse. Survival rates for people with alcoholic hepatitis who stop drinking are significantly better than survival rates for people who continue drinking.

If you are dependent on alcohol and want to stop drinking, your doctor can recommend a therapy that’s tailored for your needs. Treatment might include:

• Medications
• Counseling
• Alcoholics Anonymous or other support groups
• Outpatient or residential treatment program

Treatment for malnutrition

Your doctor might recommend a special diet to correct nutritional problems. You might be referred to a dietitian who can suggest ways to increase your consumption of the vitamins and nutrients you lack, including vitamin B1 (thiamine).

If you have trouble eating, your doctor might recommend tube feeding. A tube is passed down your throat or through your side and into your stomach. A special nutrient-rich liquid diet is then passed through the tube.

Medications to reduce liver inflammation

If you have severe alcoholic hepatitis, your doctor might recommend:

• Corticosteroids. These medications have shown some short-term benefit in increasing survival of certain people with severe alcoholic hepatitis. However, corticosteroids have serious side effects and generally aren’t prescribed if you have failing kidneys, gastrointestinal bleeding or an infection.
• Pentoxifylline. Your doctor might recommend this anti-inflammatory medication if you have severe alcoholic hepatitis and can’t take corticosteroids. The overall benefit of pentoxifylline for alcoholic hepatitis isn’t clear. Studies indicate that pentoxifylline might not be effective for people with mild alcoholic hepatitis or for people who haven’t responded to steroid treatment.

Liver transplant

For many people with severe alcoholic hepatitis, a liver transplant is the only hope to avoid death. Survival rates for liver transplant for alcoholic hepatitis are similar to survival rates for transplants associated with other types of liver disease.

However, most transplant centers are reluctant to perform liver transplants on people with alcoholic liver disease because of the fear they will resume drinking after surgery. For transplant to be an option, you would need:

• To find a program that will consider you
• To meet the requirements of the program, including abstaining from alcohol for six months before transplant and agreeing not to resume drinking afterward

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