What is Alcoholic Hepatitis?
Alcoholic hepatitis (AH) is one of several alcohol-related conditions that make up a spectrum of alcoholic liver diseases. AH is associated with long-term heavy alcohol use and is a syndrome of progressive inflammatory liver injury.1 The condition may range in severity but, in many cases, is likely to undergo some degree of recovery after drinking stops and abstinence is maintained.
The liver helps to metabolize and clear toxins from the blood, regulate blood sugar and cholesterol levels, fight infection and disease, and aid in digestion.2 When inflammation due to heavy drinking develops, it can lead to progressive liver cell damage, disrupting the organ’s ability to perform its proper functions.3,4 Alcohol-related cirrhosis of the liver may develop as a person progresses towards end-stage alcoholic liver disease, and is a condition characterized by irreversible scarring of the liver, a dangerous decline in liver function, eventual liver failure and death.4,5 According to the Centers for Disease Control and Prevention (CDC), 22,246 people in the U.S. died of alcoholic liver disease in 2017.6
What Causes Alcoholic Hepatitis?
The longer a person drinks alcohol and the more they consume, the higher the chances of them developing alcoholic liver disease.4 While it does not develop in all heavy drinkers, it is common in people between ages 40-50.4 Men are also more likely to develop the disease than women, but women can develop it after less exposure to alcohol.4
According to the Dietary Guidelines for Americans 2015-2020, a woman consuming up to 1 drink per day and up to 2 drinks per day for men is considered moderate drinking.7 The National Institute of Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that raises blood alcohol concentration (BAC) levels to 0.08 g/dL. In about a 2-hour time period, this is around 4 drinks for women and 5 drinks for men.7
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines heavy alcohol use as the occurrence of 5 or more days of binge drinking episodes within the past month.7
What Are The Symptoms?
Depending on the degree of impairment to various liver functions, there may be no symptoms at all, or they will present gradually.4 Early symptoms may include:4
- Belly pain.
- Small, red spider web-like blood vessels on the skin (i.e., spider angioma).
- Loss of energy.
- Poor appetite and weight loss.
Acute symptoms may worsen after heavy drinking.4 Over time, as liver function worsens, symptoms may progress to:4
- Jaundice (the yellowing of the skin or eyes).
- Easy bruising and unusual bleeding.
- Palms of the hands redden.
- Problem thinking or confusion (hepatic encephalopathy).
- Asterixis (a flapping like hand tremor seen in association with hepatic encephalopathy).
- Clay-colored or pale stools.
- Fluid buildup in the abdomen (ascites) and of the legs (edema).
- Impotence, shrinking of the testicles, and breast swelling in men.
The most effective management of alcoholic hepatitis is to stop drinking altogether.2,4 Those with the disease are also recommended to maintain a healthy diet, low in salt.4 Physicians may prescribe medications such as antibiotics for infections, water pills (diuretics) to eliminate fluid buildup, or Vitamin K to support normal blood clotting and minimize excess bleeding.4
For severe cases, other treatments may include removal of fluid from the abdomen, endoscopic treatments for enlarged veins in the esophagus or the placement of a transjugular intrahepatic portosystemic shunt (TIPS) to restore blood flow in the liver.4 A liver transplant may be needed if cirrhosis progresses to end-stage liver disease.2,4
Alcohol Use Disorders and Alcoholic Hepatitis
Many people who develop alcohol-related liver disease struggle with what’s known as an alcohol use disorder (AUD). Furthermore, in addition to varying states of progressive liver disease, people with AUD are likely to have developed significant physiological dependence to alcohol and are at risk of experiencing unpleasant and potentially risky alcohol withdrawal symptoms when stopping use.8 The knowledge of an impending withdrawal syndrome can make it that much more difficult for a person to take the steps necessary to begin recovery.
Acute alcohol withdrawal symptoms vary in severity from mild to physically dangerous and may be experienced as soon as 8 hours after the last time alcohol is consumed.8 Given the likelihood of marked physical dependence, people who have with longstanding, compulsive, or otherwise problematic patterns of drinking behavior should not quit drinking cold turkey without medical supervision.
The acute alcohol withdrawal syndrome may include symptoms such as headache, anxiety, insomnia, confusion, tremors, hyperthermia, diaphoresis (sweating), and racing pulse.8,9 As symptoms progress in severity, individuals may begin to experience agitation, visual and/or auditory hallucinations, or seizures.8,9
A supervised, medical detox can help people avoid unnecessary discomfort or life-threatening withdrawal complications. Detoxing can be done on an inpatient or outpatient basis, depending on the level of physical dependence and the degree of supervised care required to keep a person safe. Outpatient detox may be a less common setting for many instances of alcohol withdrawal management, and reserved for those deemed unlikely to experience severe and or complicated withdrawal after undergoing a thorough medical evaluation and assessment of withdrawal risks.
Following successful detox and withdrawal management, an inpatient or outpatient rehabilitation program may be recommended to allow further work toward recovery and relapse prevention.
. U.S. National Library of Medicine. (2011). Symptoms and signs of acute alcoholic hepatitis.
. National Health Services (UK). (2018). Alcohol-related liver disease.
. John Hopkins Medicine. (n.d.). Alcoholic Hepatitis.
. MedlinePlus. (2017). Alcoholic liver disease.
. National Health Services (UK). (2017). Cirrhosis.
. Centers for Disease Control and Prevention. (2019). Deaths: Final Data for 2017. National Vital Statistics Report, 68(9), 35.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking Levels Defined.
. MedlinePlus (2016). Alcohol Withdrawal.
. Kattimani, S. and Bharadwaj, B. (2013). Clinical Management of Alcohol Withdrawal: A Systematic Review. Ind Psychiatry; Jul-Dec 22 (2); 100-108.