Diagnosis

Your doctor will conduct a physical examination and ask about your history of alcohol consumption. It is important to be honest in describing your drinking habits. Your doctor might ask to interview family members about your drinking.

To test for liver disease, your doctor might recommend:

  • Liver function tests
  • Blood tests
  • An ultrasound, CT or MRI scan of the liver
  • A liver biopsy, if other tests and imaging don't provide a clear diagnosis or if you are at risk of other causes of hepatitis

Treatment

Treatment for alcoholic hepatitis involves drinking cessation and therapies to ease the signs and symptoms of liver damage.

Drinking cessation

If you've been diagnosed with alcoholic hepatitis, you must stop drinking alcohol and never drink alcohol again. It's the only way of possibly reversing liver damage or preventing the disease from becoming worse. Survival rates for people with alcoholic hepatitis who stop drinking are significantly better than survival rates for people who continue drinking.

If you are dependent on alcohol and want to stop drinking, your doctor can recommend a therapy that's tailored for your needs. Treatment might include:

  • Medications
  • Counseling
  • Alcoholics Anonymous or other support groups
  • Outpatient or residential treatment program

Treatment for malnutrition

Your doctor might recommend a special diet to correct nutritional problems. You might be referred to a dietitian who can suggest ways to increase your consumption of the vitamins and nutrients you lack, including vitamin B1 (thiamine).

If you have trouble eating, your doctor might recommend tube feeding. A tube is passed down your throat or through your side and into your stomach. A special nutrient-rich liquid diet is then passed through the tube.

Medications to reduce liver inflammation

If you have severe alcoholic hepatitis, your doctor might recommend:

  • Corticosteroids. These medications have shown some short-term benefit in increasing survival of certain people with severe alcoholic hepatitis. However, corticosteroids have serious side effects and generally aren't prescribed if you have failing kidneys, gastrointestinal bleeding or an infection.
  • Pentoxifylline. Your doctor might recommend this anti-inflammatory medication if you have severe alcoholic hepatitis and can't take corticosteroids. The overall benefit of pentoxifylline for alcoholic hepatitis isn't clear. Studies indicate that pentoxifylline might not be effective for people with mild alcoholic hepatitis or for people who haven't responded to steroid treatment.

Liver transplant

For many people with severe alcoholic hepatitis, the risk of death is high without a liver transplant.

Historically, those with alcoholic hepatitis have not been liver transplant candidates because of the risk that they will return to harmful drinking after transplant. Recent studies, however, suggest that carefully selected patients with severe alcoholic hepatitis have post-transplant survival rates similar to those of liver transplant recipients with other types of liver disease.

For transplant to be an option, you would need:

  • To find a program that works with liver transplant patients who have alcoholic hepatitis
  • To meet the requirements of the program, which would include lifelong commitment to alcohol abstinence as well as other requirements of the specific transplant center

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Preparing for your appointment

You may be referred to a digestive disease specialist (gastroenterologist).

What you can do

  • Be aware of any pre-appointment restrictions, such as restricting your diet.
  • Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life. Track your alcohol consumption for a few days so you can let your doctor know how much you regularly consume.
  • Write down questions to ask your doctor.
  • Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

  • What's the most likely cause of my symptoms? Are there any other possible causes?
  • What tests do I need? Is there any special preparation for them?
  • Is my condition temporary or chronic?
  • What treatments are available? Which one do you recommend?
  • I have other health problems. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

  • What are your symptoms, and when did they begin?
  • How severe are your symptoms? Are they occasional or continuous?
  • Does anything improve or worsen your symptoms?
  • How often do you drink alcohol, and how many drinks do you usually consume?
  • Have you ever had hepatitis or yellowing of the skin?
  • Do you use any other recreational drugs?
  • Are your family members or friends concerned about your drinking? Have you had social consequences — such as an arrest — because of your drinking?
  • Do you get angry or anxious when the subject of your drinking is discussed?
  • Do you feel guilty about drinking?
  • Do you drink in the morning — do you need an eye-opener?
March 27, 2018
References
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  10. Anderson-Shaw L, et al. Ethical issues in liver transplantation. http://www.uptodate.com/home. Accessed Sept. 11, 2015.
  11. Cirrhosis. National Heart, Lung, and Blood Institute. http://www.niddk.nih.gov/health-information/health-topics/liver-disease/cirrhosis/Pages/facts.aspx#cause. Accessed Sept. 12, 2015.
  12. Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 1, 2015.
  13. Mellinger JL, et al. Transplantation for alcohol-related liver disease: Is it fair? Alcohol and Alcoholism. 2017. 50:1.
  14. Lee BP, et al. Early liver transplantation for severe alcoholic hepatitis: moving from controversy to consensus. Current Opinion in Organ Transplantation. 2018. 2:229.
  15. Weeks SR, et al. Liver transplantation for severe alcoholic hepatitis, updated lessons from the world’s largest series. Journal of the American College of Surgeons. 2018. Accessed Feb. 20, 2018.