Alcoholic hepatitis is a common condition among heavy drinkers, with approximately 20% developing fatty liver, the first stage of the disease. About 10% to 15% of heavy drinkers reach cirrhosis, the final stage of alcoholic hepatitis. However, a common undiagnosed or misdiagnosed condition, some still have questions about alcoholic hepatitis. Let’s explore some of the most frequently asked questions about this condition.
1. What is Alcoholic Hepatitis?
Alcoholic hepatitis is a liver disease caused by alcohol consumption. The liver can tolerate up to a certain amount of alcohol and regenerate damaged cells and tissues. When alcohol consumption exceeds the liver’s limits for long periods, the liver becomes inflamed, and scars accumulate in the damaged areas, disrupting normal function and causing symptoms in other organs.
Alcoholic hepatitis has three stages, each more severe than the last:
- Stage 1 – Alcoholic fatty liver disease: the liver suffers inflammation and enlarges, accumulating fatty tissue. The liver can become fatty within a few days of heavy drinking and is reversible if the person stops drinking. Fatty liver has no symptoms.
- Stage 2 – Alcoholic hepatitis: after years of alcohol abuse (generally five or more), alcoholic hepatitis develops. Symptoms appear, but there’s still time to prevent further damage if the person stops drinking. It can be life-threatening in severe cases.
- Stage 3 – Cirrhosis: the final and most severe stage with a higher potential to be lethal. The scarring has become so extensive that liver failure is likely, and chances of survival may be around 50% in 5 years. Abstinence is necessary to prevent further damage and improve outcomes.
2. What are the Symptoms of Alcoholic Hepatitis?
One of the biggest issues with alcoholic hepatitis is that it can remain asymptomatic for years before the illness advances. Mostly, people who don’t get annual health checks will only recognize alcoholic hepatitis when it reaches the end of stage two and the beginning of cirrhosis.
The most common signs and symptoms of hepatitis include:
- Yellowing of the skin, teeth, and white of the eyes (jaundice)
- Abdominal inflammation and pain
- Fatigue and overall weakness
- Appetite loss and subsequent weight loss and unexplained malnourishment
- Nausea and vomiting
- Built-up fluids in the abdomen
- Fever
- Light-colored feces
As the condition worsens, most people will also experience the following:
- High fever.
- Severe feelings of weakness and fatigue
- Faster-than-normal heart rate
- Thrombocytopenia (frequent bruises and bleeding)
- Confusion and cognitive deterioration (hepatic encephalopathy)
- Severe liver scarring
- Higher likelihood of tumor formation and development of liver cancer
3. How is Alcoholic Hepatitis Diagnosed?
Because alcoholic hepatitis shares symptoms with other diseases, sometimes it remains undiagnosed. However, there are a series of tests that can help diagnose alcoholic hepatitis:
- Blood tests determine whether there are infections, cirrhosis, thrombocytopenia, and other symptoms.
- Abdominal imaging, especially ultrasound, computer tomography (CT), and magnetic resonance imaging (MRI) scans, especially in the upper right abdomen section.
- Liver function tests (LFTs). Specific blood tests measure levels of proteins, enzymes, and bilirubin. LFTs help determine the scope of liver damage.
- Liver biopsy. A biopsy is extracting a small tissue sample to perform tests and determine the extent of organ damage. A biopsy may be necessary if other tests have been inconclusive.
- Endoscopy in the esophagus to determine whether varices have formed. Varices are an advanced symptom that may lead to internal bleeding, a life-threatening condition.
Tests can help determine whether a patient has alcoholic hepatitis, some other form of hepatitis, or both. It can also help determine the extent of the damage for treatment planning.
4. What are the Treatment Options for Alcoholic Hepatitis?
There are various treatment alternatives for alcoholic hepatitis:
- Abstinence. Alcohol abstinence is the number one factor that helps patients prevent further damage and potentially regenerate at least some of the damaged tissue (in cases without extensive scarring). Alcohol rehabilitation services may be necessary.
- Nutritional support for malnourishment. Alcoholic hepatitis patients are often malnourished due to a diminished appetite caused by alcohol consumption. A nutritionist can help them identify deficiencies and provide advice to compensate for them.
- Short-term steroid use in severe cases. Although controversial due to potential side effects, short-term steroid use can increase survival rates in severe cases.
- Liver transplants. Transplants are partial or total replacements of the patient’s organ with liver tissue from a donor. Transplants are reserved for severe cases where medical therapy is no longer effective.
Treatment for alcoholic hepatitis should be accompanied by lifestyle changes on the patient’s side, including a commitment to proper long-term nutrition and regular exercise. It’s essential to seek medical treatment as soon as possible when symptoms appear. An early diagnosis when the disease has not yet advanced to the later stages can help improve outcomes and quality of life.
5. How Can Alcoholic Hepatitis Be Prevented? Can It Be Cured?
Alcohol reduction or abstinence combined with improvements in overall nutrition is the best way to prevent alcoholic hepatitis.
As part of treatment for ongoing alcoholic hepatitis, abstinence, and good nutrition help alleviate symptoms and prevent further damage.
At the fatty liver stage, several weeks of sobriety improve the condition. At the alcoholic hepatitis stage, permanent abstinence is recommended and will lead to a gradual recovery from symptoms. At the cirrhosis stage, scarring is generally irreversible, but quitting alcohol helps prevent further scarring and damage.
Whether it can be cured depends on how advanced it has become. At early stages, it can be reversed, but at later stages, it may become a chronic illness that can only be managed rather than cured.
Treating Alcoholism Helps Prevent Alcoholic Hepatitis
It usually takes multiple years of regular alcohol abuse for alcoholic hepatitis to develop. Still, one of the problems is that the first stage of the disease, fatty liver, shows no symptoms. Treating alcoholism early is the best way to prevent alcoholic hepatitis.
Don’t wait until alcoholic hepatitis has taken hold. Seeking treatment early is the best way to prevent alcoholic hepatitis and create healthier habits that can last a lifetime. If you or someone you love is struggling with alcohol abuse, consider seeking help from an addiction specialist to prevent consequences like alcoholic hepatitis.
