3 Alcoholic Liver Disease Conditions

Fatty Liver, Alcoholic Hepatitis and Cirrhosis

Doctor With Hospital Patient
Alcohol Liver Disease a Threat to Heavy Drinkers. © Getty Images

A healthy, functioning liver is vital for maintaining good health. The liver performs many essential functions including storing vital energy and nutrients, manufacturing proteins and enzymes, protecting the body from disease, and breaking down and helping remove harmful toxins.

As far as the liver is concerned, alcohol is a poison. It works to break down alcohol quickly so that it can be eliminated from the body as rapidly as possible.

Because the liver is the organ than metabolizes most of the alcohol that a person consumes, it is particularly vulnerable to alcohol-related damage. The liver breaks down alcohol into acetaldehyde, a highly toxic substance and a known carcinogen.

Although acetaldehyde is quickly broken down further, it can still cause serious damage to the tissues in the liver, which can be fatal.

Approximately 10 to 35% of heavy drinkers develop alcoholic hepatitis, and 10 to 20% develop cirrhosis. It is a major public health problem.

Three Alcoholic Liver Disease Conditions

Alcoholic liver disease includes three conditions:

  • Fatty liver
  • Alcoholic hepatitis
  • Cirrhosis

Fatty Liver - Steatosis, also called "fatty liver," can begin to develop as a result of heavy drinking for as little as a few days. The most common alcohol-related liver disease, steatosis is the earliest stage of alcoholic liver disease.

Steatosis is an excessive build-up of fat inside the liver's cells.

This condition can be reversed if the person stops drinking soon enough.

Alcoholic Hepatitis - Alcoholic hepatitis is an inflammation of the liver that can cause lack of appetite, nausea and vomiting, fever, abdominal pain, jaundice, and sometimes mental confusion.

Alcoholic hepatitis is caused by heavy drinking for a long period of time.

It is severe and potentially fatal. Some researchers believe it leads to cirrhosis. Up to 70% of people with alcoholic hepatitis end up developing cirrhosis.

Cirrhosis of the Liver - Cirrhosis occurs when healthy liver cells are replaced by fibrosis (scar tissue) which renders the liver incapable of performing its vital functions. It is the fourth leading cause of death in people ages 45-54.

Alcoholic hepatitis patients who stop drinking sometimes have a complete recovery from alcoholic liver disease, but sometimes they continue to develop cirrhosis even with abstinence.

Who Gets Alcoholic Liver Disease?

How much you drink is the most significant factor in whether or not you develop alcoholic liver disease, but other factors can play a role, too. Other risk factors include ethnic and racial background, gender, age, education, income, employment, and a family history of drinking problems.

Women are at a greater risk than men for developing cirrhosis. Scientists believe that the way alcohol is metabolized by women puts them at greater risk for alcoholic liver disease.

Research has found that women's stomach contains less of the enzyme needed for the initial breakdown of alcohol, so women metabolize alcohol at a slower rate and more alcohol makes it into their livers and remains for longer periods of time.

How Is Alcoholic Liver Disease Diagnosed?

A history of heavy alcohol use is one of the best indicators that someone may have alcoholic liver disease, but typically heavy drinkers will minimize or deny their alcohol abuse to their healthcare providers and the condition goes undiagnosed because physical exams and blood work may not specifically point to alcoholic liver disease.

Testing the blood levels of three liver enzymes - gamma–glutamyltransferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) - can sometimes indicate alcoholic liver disease.

Studies have found that in 80% of alcoholic liver disease patients the AST level is more than twice the level of ALT.

Also, an elevated level of GGT is indicative of heavy alcohol use and liver injury, but other drugs can increase GGT levels.

If you are concerned that you may be developing alcoholic liver disease, the best approach would be to be completely honest with your primary care provider about your history of alcohol use.

Treatment for Alcoholic Liver Disease

Treatment approaches for alcoholic liver disease include:

  • Lifestyle changes
  • Nutritional therapy
  • Pharmacological therapy
  • Liver transplantation

Lifestyle Changes

Abstinence from alcohol is essential to prevent further liver injury, scarring and possibly liver cancer. Although quitting drinking may or may not stop the progression of alcoholic liver disease, every study has shown that it is beneficial to stop at all stages of the disease.

Research also shows that scarring of the liver takes place more rapidly in patients who smoke tobacco, therefore cessation of smoking is also recommended for alcoholic liver disease patients.

Obesity has also been linked to the development of fatty liver and nonalcoholic steatohepatitis, a disorder similar to alcoholic hepatitis. Maintaining a health body weight can reduce or prevent further liver damage, experts say.

Nutritional Treatment

Many alcoholics suffer from nutritional deficiencies, which can lead to liver damage and impaired liver function. Maintaining a balance diet can help prevent further injury to the liver.

Dietary supplements can help prevent or relieve some of alcohol's harmful effects, not only on the liver but other areas of the body. It is recommended that all alcoholics in treatment be given vitamin B1 to help prevent brain damage caused by a deficiency of thiamine experienced by many chronic drinkers.

Emerging Therapies

Some studies have found that medium-chain triglycerides (MCTs) can help reduce increased fats in liver cells. MCTs are available in health food stores.

Research has found that when the molecule S–adenosylmethionine (SAMe) was given to patients with alcoholic cirrhosis in a clinical trial they were less likely to die and less likely to need a transplant within the next two years. The study found no harmful side effects from SAMe treatment.

Pharmacological Therapy

There are no FDA approved medications for alcoholic hepatitis or alcoholic cirrhosis. Some drugs have been used "off label" with limited results. Pentoxifylline (PTX) and corticosteroids have been found to improve survival rates, but only short-term.

Corticosteroids improve survival rates significantly for 28 days, but the advantages did not extend much longer than a year. It is therefore recommended that corticosteroids be used only for the most severe patients.

Liver Transplantation

Currently, liver transplantation is the only definitive treatment for severe liver failure. In order to obtain a transplant, alcoholic liver disease patients have to be evaluated for other medical problems that could affect the outcome, including heart damage, cancer, pancreatitis, and osteoporosis.

Liver transplant patients have to maintain a rigid medical regimen to take the necessary antirejection medications and they also have to remain abstinent from alcohol. Therefore, the pre-transplant evaluation includes a psychological evaluation to determine which patients are most likely to meet those criteria.

Transplant Controversy

Due to the high demand from hepatitis C and alcoholic cirrhosis patients for a limited number of donated organs, liver transplants for alcoholic liver disease patients remains controversial. The controversy has been fueled by a few high-profile cases in which transplant recipients very publicly returned to drinking.

However, research has found that in patients following liver transplant:

  • Relapse rates are lower for transplant patients than those undergoing alcoholism treatment.
  • Hepatitis B or C patients are more likely to lose a transplanted liver because of an infection recurrence that alcoholic liver patients are likely to due to relapse.
  • Compliance by alcoholic liver disease patients to antirejection medications are comparable to rates for other liver patients.
  • Alcoholic liver disease transplant patients use no more resources that non-alcoholic liver disease patients, contrary to belief.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that the long-term costs of managing alcoholism and alcoholic liver disease may be higher than the long-term costs of transplantation.

The NIAAA supports liver transplants for alcoholic liver disease patients because of the overall improvement in their lives, including higher productivity and a higher quality of life.


National Institute on Alcohol Abuse and Alcoholism. "Alcoholic Liver Disease." Alcohol Alert January 2005

National Institute on Alcohol Abuse and Alcoholism. "Alcohol and the Liver: Research Update." Alcohol Alert July 1998

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