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.
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
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.
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 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.
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 for alcoholic hepatitis involves drinking cessation and therapies to ease the signs and symptoms of liver damage.
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:
- 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.
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
You may be referred to a digestive disease specialist (gastroenterologist).
What you can do
- Be aware of any pre-appointment restrictions, such as restricting your diet.
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all your medications, vitamins and supplements.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life. Track your alcohol consumption for a few days so you can let your doctor know how much you regularly consume.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your doctor
- What's the most likely cause of my symptoms? Are there any other possible causes?
- What tests do I need? Is there any special preparation for them?
- Is my condition temporary or chronic?
- What treatments are available? Which one do you recommend?
- I have other health problems. How can I best manage these conditions together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:
- What are your symptoms, and when did they begin?
- How severe are your symptoms? Are they occasional or continuous?
- Does anything improve or worsen your symptoms?
- How often do you drink alcohol, and how many drinks do you usually consume?
- Have you ever had hepatitis or yellowing of the skin?
- Do you use any other recreational drugs?
- Are your family members or friends concerned about your drinking? Have you had social consequences — such as an arrest— because of your drinking?
- Do you get angry or anxious when the subject of your drinking is discussed?
- Do you feel guilty about drinking?
- Do you drink in the morning — do you need an eye-opener?
You might reduce your risk of alcoholic hepatitis if you:
- Drink alcohol in moderation, if at all. For healthy adults, moderate drinking means up to one drink a day for women and up to two drinks a day for men. The only certain way to prevent alcoholic hepatitis is to avoid all alcohol.
- Protect yourself from hepatitis C. Hepatitis C is an infectious liver disease caused by a virus. Untreated, it can lead to cirrhosis. If you have hepatitis C and drink alcohol, you're far more likely to develop cirrhosis than is someone who doesn't drink.
- Check before mixing medications and alcohol. Ask your doctor if it's safe to drink alcohol when taking your prescription medications. Read the warning labels on over-the-counter medications. Don't drink alcohol when taking medications that warn of complications when combined with alcohol — especially pain relievers such as acetaminophen (Tylenol, others).