Author: James Anderson

Alcohol-Associated Liver Disease

To determine if you have alcoholic liver disease your doctor will probably test your blood, take a biopsy of the liver, and do a liver function test. You should also have other tests to rule out other diseases that could be causing your symptoms. Your symptoms may vary depending upon the severity of your disease.

1. Long-term survival in patients with alcoholic hepatitis who discontinue alcohol use is significantly longer than in patients who continue to drink.
2. The spectrum of ALD can include simple hepatic steatosis, acute alcoholic hepatitis, and alcoholic cirrhosis.
3. Since you may not have any symptoms in the early stages of the disease, cirrhosis is often detected through routine blood tests or checkups.
4. Liver damage occurs through several interrelated pathways.
5. They’re often due to blocked blood flow through the portal vein.

Patients with severe alcohol-related hepatitis may be treated with corticosteroids, such as prednisolone, to reduce some of the liver inflammation. During the physical exam, the doctor will feel the abdomen to assess the size and tenderness of the liver. They can also determine whether the spleen is enlarged, which may be a sign of advanced liver disease. In the United States, the consumption of alcohol is often woven into the fabric of social life. Close to 90% of adults in the United States have had an alcoholic beverage at some point in their life, and when asked about their drinking habits, around 55% report having had a drink within the past month. A liver transplant may become necessary in end-stage ALD.

And heavy drinkers get most of their calories from alcohol. Alcoholic liver disease does not occur in all heavy drinkers. The chances of getting liver disease go up the longer you have been drinking and more alcohol you consume. People with early-stage cirrhosis of the liver usually don’t have symptoms. Often, cirrhosis is first found through a routine blood test or checkup. To help confirm a diagnosis, a combination of laboratory and imaging tests is usually done.

Risk factors for alcohol-related liver disease

What is known about the epidemiology of liver disease has changed due to a better understanding of nonalcoholic fatty liver disease and chronic viral hepatitis. The outlook for people with ALD depends on the severity of liver damage, the presence of risk factors and complications, and their ability to permanently stop drinking. In general, those with mild disease, who have no or few risk factors and complications, and who remain abstinent have better outcomes. While the occasional alcoholic drink is not usually harmful, excessive alcohol consumption can lead to a number of health consequences.

However, if the disease progresses, it is often not reversible. Medications and lifestyle modifications may also be prescribed depending on the stage. Although 90% of people who drink heavily develop fatty liver disease, only 20% to 40% will go on to develop alcoholic hepatitis.

Mayo Clinic Press

Limit the amount of salt in your diet to less than two grams of total intake a day. Make an appointment with your health care provider if you have any of the symptoms listed above. The liver also filters and removes toxic substances—like alcohol—from the blood. When a person drinks alcohol, the alcohol passes into stomach and intestines where it is absorbed into the bloodstream. In turn, the alcohol-containing blood is transported to the liver. In order to understand alcohol’s effect on the liver, it’s helpful to know the role of the liver in overall health.

The overall clinical diagnosis of alcoholic liver disease, using a combination of physical findings, laboratory values, and clinical acumen, is relatively accurate (Table 3). However, liver biopsy can be justified in selected cases, especially when the diagnosis is in question. A clinical suspicion of alcoholic hepatitis may be inaccurate in up to 30% of patients. Cirrhosis has historically been considered an irreversible outcome following severe and prolonged liver damage. However, studies involving patients with liver disease from many distinct causes have shown convincingly that fibrosis and cirrhosis might have a component of reversibility.

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Still, around 10 to 20% of people who develop alcohol-related fatty liver disease go on to develop cirrhosis. People with alcohol-related cirrhosis tend to have a less favorable prognosis, in part because the liver scarring cannot be reversed and additional complications may develop. For these patients, a liver transplant is often the best option. For patients with severe alcohol-related hepatitis or severe alcohol-related cirrhosis who aren’t helped by other therapies, liver transplantation may be an option. During a liver transplantation, a surgeon replaces the patient’s damaged liver with all or part of a healthy liver from a deceased or a living donor.

Epidemiology and Risk Factors

Alcoholic hepatitis is caused by damage to the liver from drinking alcohol. Just how alcohol damages the liver and why it does so only in some heavy drinkers isn’t clear. Alcoholic hepatitis is swelling, called inflammation, of the liver caused by drinking alcohol. Alcoholic liver disease is treatable if it is caught before it causes severe damage. However, continued excessive drinking can shorten your lifespan.

For more than a decade, alcoholic cirrhosis has been the second leading indication for liver transplantation in the U.S. Most transplantation centers require 6-months of sobriety prior to be considered for transplantation. This requirement theoretically has a dual advantage of predicting long-term sobriety and allowing recovery of liver function from acute alcoholic hepatitis. This rule proves disadvantageous to those with severe alcoholic hepatitis because 70% to 80% may die within that period. Relapse after transplantation appears to be no more frequent than it is in patients with alcoholic cirrhosis who do not have alcoholic hepatitis. Established alcoholic cirrhosis can manifest with decompensation without a preceding history of fatty liver or alcoholic hepatitis.