Alcoholic Liver Disease

Heavy alcohol consumption can lead to progressive liver disease. Initially fat builds up in the liver and causes inflammation (alcoholic steatohepatitis). This chronic inflammation can progress to cirrhosis and liver cancer. Once alcoholic liver disease develops, continued alcohol use typically leads to complications of liver disease. One severe manifestation of alcoholic liver disease is acute alcoholic hepatitis, which is a dangerous condition with a high risk of death. This is typically associated with jaundice and often requires specific treatment in addition to stopping all alcohol.

It is estimated that up to 20 percent of patients with alcoholic fatty liver will progress to alcoholic cirrhosis. Factors associated with an increased risk of progression to cirrhosis include ongoing alcohol use, daily drinking rather than periodic binge drinking, obesity, female sex and superimposed liver disease such as hepatitis C.

Alcoholic liver disease is suspected when there is a history of heavy alcohol use, elevated liver enzymes, suggestion of fatty liver on imaging tests, or is found on a liver biopsy.

Key to the management of alcoholic liver disease is discontinuing all alcohol. Abstinence may allow for reversal of the liver damage induced by alcohol, if the liver disease has not progressed to cirrhosis. In the setting of cirrhosis, alcohol abstinence decreases the risk of liver failure, the development of clinical complications of cirrhosis and improves survival. Liver transplantation can be an option for those patients with end-stage liver disease from alcoholic liver disease who meet the 6-month sobriety criteria and are committed to alcohol abstinence.