Alcoholic Hepatitis

Alcoholic hepatitis is inflammation of the liver caused by excessive consumption of alcohol, presenting as jaundice, abdominal tenderness and swelling, loss of appetite, and nausea and vomiting. Itself life-threatening in severe cases, alcoholic hepatitis is also a precursor to cirrhosis and a warning sign that your drinking is damaging your health.

What is alcoholic hepatitis?

Hepatitis is swelling and inflammation of the liver. Although it's most commonly a response to a viral infection—as in hepatitis A, B, and C—inflammation in the liver can also be caused by excessive alcohol consumption.

Alcoholic hepatitis is often seen as a prelude to cirrhosis, a late-stage liver disease in which inflamed cells die and are replaced by scar tissue. 70% of people with alcoholic hepatitis will develop alcoholic liver cirrhosis in their lifetimes.[1] 

Usually, patients who develop alcoholic hepatitis have drunk heavily for years: typically, eight to 10 drinks a day for at least a decade.[2] Around a third of chronic alcohol users will develop alcoholic hepatitis.[3]

However, sometimes acute alcoholic hepatitis will develop after a short period of binge drinking. It can also develop after years of more moderate drinking, particularly among people with other risk factors for liver disease, such as family history, concomitant hepatitis B or C infections, or obesity.[4]

Get help during covid-19

Get help during Covid-19

At Recovered, we recognize the impact COVID-19 has had and the continued challenges it poses to getting advice and treatment for substance use disorders. SAMHSA has a wealth of information and resources to assist providers, individuals, communities, and states during this difficult time and is ready to help in any way possible.

Speak to SAMSHA

What causes alcoholic hepatitis?

Alcohol is primarily metabolized by the liver, where it’s broken down into toxic chemicals, including acetaldehyde. Chronic alcohol use overloads the liver with these toxins and with fat, which it struggles to clear. Eventually, these toxins build up and injure liver tissue. Inflammation—hepatitis—is a reaction to that injury. 

When inflammation is severe and chronic, as in the case of continuing alcohol abuse, it damages the tissues of the liver, leading to cell death. These dead cells are replaced by scar tissue, known as fibrosis, leaving the liver incapable of metabolizing nutrients and filtering toxins. This is cirrhosis—permanent and life-threatening damage to your liver.[5]

Read here to learn more about alcohol and health conditions.

What are the symptoms of alcoholic hepatitis?

Alcoholic hepatitis can come on suddenly. If untreated, severe cases can lead to death in 40% to 50% of cases within a month.[6]

Symptoms include:

  • jaundice: yellowing of the skin and whites of the eyes

  • enlargement of the liver

  • abdominal tenderness

  • fluid accumulation in the abdomen (ascites)

  • loss of appetite

  • nausea and vomiting

  • low-grade fever

  • fatigue

  • hepatic encephalopathy, brain dysfunction caused by liver failure, presenting as confusion, personality and behavior changes, slurred speech, decreased consciousness, and a characteristic flapping hand movement.

How to prevent alcoholic hepatitis

The best way to prevent alcoholic hepatitis is to drink in moderation, if at all. Moderate drinking is less than two drinks per day for men and less than one for women.

If you have other risk factors, including hepatitis B or C, fatty liver disease, or obesity, or previously drank heavily, you should avoid all alcohol.

You should also try to avoid contracting hepatitis B and C, viruses known to increase the risk of alcoholic hepatitis. These viruses are most commonly spread through blood-to-blood contact, such as through shared needles in injection drug use or shared razors. They can less commonly be spread sexually. Vaccines are available for hepatitis B.[7]

Be careful mixing medication and alcohol. Some drugs are toxic to the liver, especially when taken alongside alcohol or by heavy drinkers. These include drugs in every medicine cabinet such as acetaminophen (Tylenol).

How is alcoholic hepatitis treated?

Abstinence from alcohol is the largest factor in recovery from alcoholic hepatitis.[8] Quitting alcohol will reduce symptoms of hepatitis, prevent further damage to your liver, and, in the early stages of liver disease, reverse existing damage. 

But even when the damage to your liver is permanent, quitting drinking can preserve the liver function you do have and significantly extend your life. Among heavy drinkers with permanent liver change, those who continued drinking had a 30% lower survival rate than those who quit.[9]

Treatment for alcoholic hepatitis may also include:

  • nutritional supplementation: heavy drinkers often have protein-calorie malnutrition, which is associated with worse outcomes. Better nutrition, often delivered through tube feeding, can improve their liver function and reduce the likelihood of complications such as infections and encephalopathy.

  • medication: this may include corticosteroids, pentoxifylline, N-acetyl cysteine (NAC), and metadoxine

  • liver transplant[10]

Alcohol addiction treatment

If you need help quitting alcohol and protecting your liver, reach out. For a list of rehabs and treatment centers near you for detox and recovery, visit our rehab directory.