Alcoholic hepatitis describes liver inflammation caused by drinking alcohol.
Though alcoholic hepatitis is most likely to occur in people who drink heavily over many years, 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.
Yellowing of the skin and whites of the eyes (jaundice) and increasing girth (due to fluid accumulation) are the most common signs of alcoholic hepatitis that lead people to seek medical care.
People may also complain of:
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:
When to see a doctor
Alcoholic hepatitis is a serious disease. As many as 35 percent of heavy drinkers develop alcoholic hepatitis. And more than a third of them die within six months after signs and symptoms begin to appear.
See your doctor if you have any signs or symptoms of alcoholic hepatitis or other signs and symptoms that worry you. If you ever feel as though you can’t control your drinking or feel that you’d like help in cutting back on your drinking, see your doctor.
Alcoholic hepatitis occurs when the liver is damaged by the alcohol you drink. Just how alcohol damages the liver — and why it does so only in a minority of heavy drinkers — isn’t clear. What is known is that the process of breaking down ethanol — the alcohol in beer, wine and liquor — produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. Over time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver’s ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.
Risk increases with time, amount consumed
Heavy alcohol use can lead to liver disease, and the risk increases with the length of time and amount of alcohol you drink. But because many people who drink heavily or binge drink never develop alcoholic hepatitis or cirrhosis, it’s likely that factors other than alcohol play a role. These include:
Major risk factors for alcoholic hepatitis comprise:
Other factors which may increase your risk include:
Complications of alcoholic hepatitis include:
Start by seeing your family doctor or a general practitioner. If your doctor thinks you have a liver problem, such as alcoholic hepatitis, you’ll likely be referred to a digestive disease specialist (gastroenterologist).
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Questions to ask your doctor
For alcoholic hepatitis, some basic questions to ask your doctor include:
Don’t hesitate to ask questions anytime you don’t understand something.
What to expect from your doctor
Be ready to answer questions that your doctor is likely to ask:
What you can do in the meantime
Stop drinking alcohol if you think it may be causing your health problems. If you believe you’re dependent on alcohol, your doctor can recommend treatment options. However, if you need help to stop drinking while you’re waiting to see your doctor, Alcoholics Anonymous or counseling may be helpful.
Identifying alcoholic liver disease depends on two main things:
Your doctor will want to know about your history of alcohol consumption. It is important to be honest in describing your drinking habits. Your doctor may ask to interview family members about your drinking. Many people will have signs of chronic alcoholism, such as skin lesions known as spider nevi.
Your doctor will likely order the following tests to look for liver disease:
Stop drinking alcohol
If you’ve been diagnosed with alcoholic hepatitis, you must stop drinking alcohol. It’s the only way of possibly reversing liver damage or, in more advanced cases, preventing the disease from becoming worse. Many people who stop drinking have dramatic improvement in symptoms in just a few months.
If you continue to drink alcohol, you’re likely to experience serious complications.
If you are dependent on alcohol and want to stop drinking, your doctor can recommend a therapy that’s tailored for your needs. This might include medications, counseling, Alcoholics Anonymous, an outpatient treatment program or a residential inpatient stay.
Treatment for malnutrition
Your doctor may recommend a special diet to reverse nutritional deficiencies that often occur in people with alcoholic hepatitis. You may be referred to a dietitian who can help you assess your current diet and suggest changes to increase the vitamins and nutrients you are lacking.
If you have trouble eating enough to get the vitamins and nutrients your body needs, your doctor may recommend tube feeding. This may involve passing a tube down your throat and into your stomach. A special nutrient-rich liquid diet is then passed through the tube.
Medications to reduce liver inflammation
Your doctor may recommend corticosteroids drugs if you have severe alcoholic hepatitis. These drugs have shown some short-term benefit in increasing survival. Steroids have significant side effects and are not recommended if you have failing kidneys, gastrointestinal bleeding or an infection. About 40 percent of people do not respond to corticosteroids. Your doctor may also recommend pentoxifylline, especially if corticosteroids don’t work for you. Some studies of pentoxifylline have shown some benefit, others have not. You might also ask about clinical trials of other therapies.
For many people with severe alcoholic hepatitis, liver transplant is the only hope to avoid death. Survival rates for liver transplant for alcoholic hepatitis are similar to those for other forms of hepatitis, greater than 70 percent five-year survival.
However, most medical centers are reluctant to perform liver transplants on people with alcoholic liver disease because of the fear they will resume drinking after surgery. For most people with alcoholic hepatitis, the disease is considered a contraindication for liver transplantation in most transplant centers in the U.S.
For transplant to be an option, you would need to find a program that will consider you. You would have to meet the requirements of the program, including abstaining from alcohol for six months prior to transplant and agreeing not to resume drinking afterward.
No alternative medicine treatments have been found to cure alcoholic hepatitis. Some herbs and supplements are touted as treatments for liver diseases. Herbs and supplements can’t replace your doctor’s treatments or abstaining from alcohol. If you’d like to try supplements, talk to your doctor about the risks and benefits first.
The leaves and seeds of the milk thistle plant are thought to control inflammation in the liver. Milk thistle supplements are a popular alternative treatment among people with liver disease. But studies haven’t found a benefit for people with alcoholic liver disease who take milk thistle supplements.
Milk thistle is generally safe, but can cause diarrhea and nausea. Talk to your doctor about milk thistle if you’re considering taking this supplement. Because milk thistle can interfere with prescription medications, ask your doctor whether it’s safe for you
SAMe is a supplement that’s thought to reduce liver inflammation and help the liver repair itself. Your body naturally makes SAMe. Some evidence suggests people with liver disease have a deficiency of SAMe. In theory, taking a SAMe supplement might restore levels of the substance in the liver. But there is insufficient evidence to recommend use of SAMe for alcohol-related liver disease.
You may reduce your risk of alcoholic hepatitis if you:
Contaminated drug paraphernalia is responsible for the majority of new cases of hepatitis C. Don’t share needles or other drug paraphernalia. Hepatitis C can sometimes be transmitted sexually. If you aren’t absolutely certain of the health status of a sexual partner, use a new condom every time you have sex. See your doctor if you have or have had hepatitis C or think you may have been exposed to the virus.