What's to know about alcoholic liver disease?
The liver is one of the most complex organs in the human body, with over 500 functions. These include filtering out blood toxins, storing energy, making hormones and proteins, and regulating cholesterol and blood sugar.
Liver damage can affect the whole body. Once damage begins, it can take a long time to become noticeable, as the liver is generally highly effective at regenerating and repairing itself. Often, by the time the damage is found, it is irreversible.
According to the Centers for Disease Control and Prevention (CDC), in 2014 the number of deaths from alcoholic liver disease in the United States was 19,388, while all causes of chronic liver disease and cirrhosis are estimated to lead to 12 fatalities per 100,000 people per year.
In 2015, in the United States, nearly 20 percent of all liver transplants occurred as a result of alcoholic liver disease, making it the third most common reason for transplant behind chronic hepatitis C and liver cancer.
Fast facts on alcoholic liver disease
- Alcoholic liver disease is the main cause of chronic liver disease in Western nations and the third most common cause of liver transplants.
- Abstaining from drinking alcohol is the only way a person has a chance of recovery.
- Jaundice and tremors are symptoms of alcoholic liver disease.
- Treatment options include medication, lifestyle changes, and surgery.
- The recommended daily limits are no more than one drink a day for women and no more than two drinks a day for men.
Early signs
Along with a general feeling of being unwell, signs can include:
- pain in the abdomen
- nausea and vomiting
- diarrhea
- decreased appetite
Symptoms
Once alcoholic liver disease progresses, its symptoms become easier to recognize.The more distinctive signs of later-stage liver disease include the following:
- jaundice, or a yellow tint of the whites of the eyes and the skin
- edema, or swelling of the lower limbs
- a buildup of fluid in the abdomen, known as ascites
- fever and shivering
- extremely itchy skin
- fingernails that curve excessively, known as clubbing
- losing a significant amount of weight
- general weakness and wasting muscles
- blood in vomit and stools
- bleeding and bruising more easily
- more sensitive reactions to alcohol and drugs
Treatment
The first step in treating any level of alcoholic liver disease focuses on removing alcohol from the diet.Abstinence
Once a person is diagnosed with alcoholic liver disease at any stage, it is recommended to never resume drinking. Any conditions that have reversed will typically return once drinking restarts.
As alcohol dependency can make it more difficult to quit drinking alcohol, it is necessary to gradually reduce alcohol intake.
Those who regularly drink more than the recommended daily limits of alcohol should not stop drinking without medical support. Withdrawal from alcohol can be life-threatening. Individuals should seek help from a medical professional to safely manage alcohol withdrawal.
The recommended daily limits are more than one drink a day for women and more than two drinks a day for men.
Cognitive behavioral therapy (CBT) and medications called benzodiazepines can be used to ease withdrawal symptoms in a person with alcohol dependency. People with severe alcohol dependency may stay at an inpatient rehabilitation facility for closer monitoring.
Ongoing therapy may then be required to prevent a relapse into drinking alcohol. Medications such as acamprosate, naltrexone, topiramate, baclofen, and disulfiram can also be used to help prevent relapse.
Lifestyle changes
Weight loss and quitting smoking might also be recommended since being overweight and smoking have both demonstrated a role in making alcoholic liver disease worse. Taking a daily multivitamin is usually recommended as well.Here is a page for purchasing a range of daily multivitamins. This will take you to an external site.
Medications
Corticosteroids or pentoxifylline may be used for reducing inflammation in people with acute alcoholic hepatitis while they are being treated in a hospital.Other medications that show potential for treatment and are currently being studied include:
- probiotics and antibiotics
- stem cell therapy
- medicines that target the inflammation pathway
Liver transplant
In people with liver failure, the liver completely ceases to function. This can be an outcome of advanced-stage liver disease and often means that a liver transplant is the only option for prolonged survival.Typically, only people who can show at least six months of abstinence from alcohol before the procedure and those with other organ systems that are healthy enough to undergo surgery will be considered for transplant.
Liver transplant is a complicated procedure that depends on a donor being available. Anti-rejection medications given after transplant can increase the risk of serious infections and certain cancers.
A liver transplant is a last resort. Quitting alcohol and treating this condition early on is the best way for a person to increase their chances of reversing or slowing the disease.
Outlook
The life expectancy of a person with alcoholic liver disease reduces dramatically as the condition progresses.On average, one out of three people with the most advanced stage of liver disease and cirrhosis are still alive after 2 years. When the body can compensate and manage cirrhosis, the typical lifespan is 6 to 12 years. Those with less severe disease will survive longer, as long as they maintain abstinence from alcohol.
Some stages of the condition can be reversed, and life expectancy can increase once a person stops drinking alcohol completely.
Not smoking, controlling body weight, and managing diabetes as well as any heart, kidney, or lung diseases are also important in lengthening and improving quality of life.
Stages
Alcoholic liver disease has four main stages.Alcoholic fatty liver disease
Drinking a large volume of alcohol can cause fatty acids to collect in the liver. Sometimes, heavy drinking over a short period, even less than a week, can cause this. There are normally no symptoms, and this stage of the disease is often reversible if the individual abstains from alcohol from this point onward.Alcoholic hepatitis
Continued alcohol use will lead to ongoing liver inflammation. This can occur after many years of heavy drinking. It can also occur acutely during periods of binge drinking. Hepatitis is a general term swelling and inflammation of the liver from any cause.If the individual abstains from alcohol on a long-term basis, alcoholic hepatitis is usually reversible.
Fibrosis
Fibrosis is a buildup of certain types of protein in the liver, including collagen. It features in most types of chronic liver disease. Mild-to-moderate forms of fibrosis may be reversible. Continuous fibrosis and inflammation can lead to liver cancer.Cirrhosis
Cirrhosis occurs when the liver has been inflamed for a long time, leading to scarring and loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible, but the patient can prevent further damage by continuing to avoid alcohol.Life-long abstinence can improve liver function, but the permanent and severe damage from cirrhosis might mean that the patient needs a liver transplant to survive.
As the liver no longer processes toxins properly, it will be more sensitive to medications and alcohol. Alcohol use speeds up the destruction of the liver, along with reducing the liver's ability to compensate for the current damage.
Risk factors
People who drink beer and liquor may be more likely to experience liver disease, when compared with those who consume other alcoholic beverages, such as wine.
According to the American College of Gastroenterology, women who consume more than two drinks a day and men who consume more than three drinks a day for more than five years are at an increased risk for alcoholic liver disease.
Women metabolize alcohol more slowly than men. They also are more likely to quickly develop fibrosis, inflammation, and liver injury as a result of alcohol. Research has shown that women are more susceptible to the negative effects of alcohol compared to men, even at the same levels of alcohol intake.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13 percent of women in the U.S. who drink alcohol consume over seven drinks a week.
Women who consume high amounts of alcohol and also carry excess body weight have a greater chance of developing chronic liver disease. However, obesity is also a risk factor for men.
Having hepatitis C increases the risk, and a person who consumes alcohol regularly and has had any type of hepatitis faces a higher chance of developing liver disease. Hepatitis C also increases the risk of developing liver cancer.
Genetic changes can affect the risk. If a person experience changes in the genetic profiles of particular enzymes that are key to alcohol metabolism, such as ADH, ALDH, and CYP4502E1, they will have a higher chance of developing alcoholic liver disease.
Causes
Not all heavy regular drinkers develop liver damage. It is not known why alcoholic liver disease affects some people and not others.Acetaldehyde is a toxic chemical that is produced by the body's break down of alcohol. It damages the liver and leads to liver scarring and inflammation.
This chemical appears to affect some people more than others.
Prevention
To prevent alcoholic liver disease and other conditions linked to the consumption of alcohol, people are advised to follow national guidelines for limits of alcohol consumption.The guidelines classify moderate drinking as up to one drink a day for women, up to two drinks for men, and only over the age of 21 years. One drink is equivalent to 12 fluid ounces (oz) of beer at 5 percent alcohol, 5 oz of wine at 12 percent alcohol, or 1.5 oz of spirits at 40 percent alcohol.
Binge drinking refers to drinking too much alcohol in a short space of time. It can increase the risk of liver damage. When a man consumes five or more drinks within 2 hours, or a woman consumes four or more drinks in the same amount of time, it is considered binge drinking.
The NIAAA also notes that different people react to alcohol in different ways, and some are more at risk than others from the effects of alcohol. Alcohol use disorder (AUD) often goes along with alcoholic liver disease. It is a form of severe problem drinking. A person has difficulty controlling alcohol intake and feels emotionally low when not using alcohol.
The guidelines identify those at high risk for an alcohol use disorder to be women who drink four or more drinks on any one day, or eight or more drinks in a week, and men who drink five or more drinks on any one day or 15 or more drinks per week.
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