Overview

Alcoholic hepatitis is inflammation of the liver caused by drinking alcohol.

Alcoholic hepatitis is most likely to occur in people who drink heavily over many years. However, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately.

If you're diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.

Symptoms

The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes (jaundice).

Other signs and symptoms include:

  • Loss of appetite
  • Nausea and vomiting
  • Abdominal tenderness
  • Fever, often low grade
  • Fatigue and weakness

Malnutrition is common in people with alcoholic hepatitis. Drinking large amounts of alcohol suppresses the appetite, and heavy drinkers get most of their calories from alcohol.

Additional signs and symptoms that occur with severe alcoholic hepatitis include:

  • Fluid accumulation in your abdomen (ascites)
  • Confusion and behavior changes due to a buildup of toxins normally broken down and eliminated by the liver
  • Kidney and liver failure

When to see a doctor

Alcoholic hepatitis is a serious, often deadly disease.

See your doctor if you:

  • Have signs or symptoms of alcoholic hepatitis
  • Can't control your drinking
  • Would like help cutting back on your drinking

Causes

Alcoholic hepatitis develops when the alcohol you drink damages your liver. Just how alcohol damages the liver — and why it does so only in some heavy drinkers — isn't clear.

These factors are known to play a role in alcoholic hepatitis:

  • The body's process for breaking down alcohol produces highly toxic chemicals.
  • These chemicals trigger inflammation that destroys liver cells.
  • Over time, scars replace healthy liver tissue, interfering with liver function.
  • This irreversible scarring (cirrhosis) is the final stage of alcoholic liver disease.

Other factors that can contribute to alcoholic hepatitis include:

  • Other types of hepatitis. If you have hepatitis C and also drink — even moderately — you're more likely to develop cirrhosis than if you don't drink.
  • Malnutrition. Many people who drink heavily are malnourished because they eat poorly or because alcohol and its byproducts prevent the body from properly absorbing nutrients. Lack of nutrients contributes to liver cell damage.

Risk factors

The major risk factor for alcoholic hepatitis is the amount of alcohol you consume. How much alcohol it takes to put you at risk of alcoholic hepatitis isn't known. But most people with the condition have a history of drinking more than 3.5 ounces (100 grams) — equivalent to seven glasses of wine, seven beers or seven shots of spirits — daily for at least 20 years.

However, alcoholic hepatitis can occur among those who drink less and have other risk factors.

Other risk factors include:

  • Your sex. Women seem to have a higher risk of developing alcoholic hepatitis possibly because of differences in the way alcohol is processed in women.
  • Obesity. Heavy drinkers who are overweight might be likelier to develop alcoholic hepatitis and to progress from that condition to cirrhosis.
  • Genetic factors. Studies suggest there may be a genetic component in alcohol-induced liver disease although it's difficult to separate genetic and environmental factors.
  • Race and ethnicity. Blacks and Hispanics might be at higher risk of alcoholic hepatitis.
  • Binge drinking. Having five or more drinks within two hours for men and four or more for women might increase your risk of alcoholic hepatitis.

Complications

Complications of alcoholic hepatitis, which result from severe liver damage, relate to scar tissue. Scar tissue can slow blood flow through your liver, increasing pressure in a major blood vessel (portal vein), and the buildup of toxins. Complications include:

  • Enlarged veins (varices). Blood that can't flow freely through the portal vein can back up into other blood vessels in the stomach and esophagus. These blood vessels have thin walls and are likely to bleed if filled with too much blood. Heavy bleeding in the upper stomach or esophagus is life-threatening and requires immediate medical care.
  • Ascites. Fluid that accumulates in the abdomen might become infected and require treatment with antibiotics. Ascites isn't life-threatening but are usually a sign of advanced alcoholic hepatitis or cirrhosis.
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The buildup of toxins can damage your brain. Severe hepatic encephalopathy can result in coma.
  • Kidney failure. A damaged liver can affect blood flow to the kidneys, resulting in damage to those organs.
  • Cirrhosis. This scarring of the liver can lead to liver failure.

Prevention

You might reduce your risk of alcoholic hepatitis if you:

  • Drink alcohol in moderation, if at all. For healthy adults, moderate drinking means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men age 65 and younger. The only certain way to prevent alcoholic hepatitis is to avoid all alcohol.
  • Protect yourself from hepatitis C. Hepatitis C is an infectious liver disease caused by a virus. Untreated, it can lead to cirrhosis. If you have hepatitis C and drink alcohol, you're far more likely to develop cirrhosis than if you didn't drink.
  • Check before mixing medications and alcohol. Ask your doctor if it's safe to drink alcohol when taking your prescription medications. Read the warning labels on over-the-counter medications. Don't drink alcohol when taking medications that warn of complications when combined with alcohol — especially pain relievers such as acetaminophen (Tylenol, others).

Nov. 30, 2018
References
  1. AskMayoExpert. Alcoholic liver disease (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  2. Friedman SL. Alcoholic hepatitis: Clinical manifestations and diagnosis. https://www.uptodate.com/contents/search. Accessed Oct. 21, 2018.
  3. Alcohol-related liver disease. American Liver Foundation. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/alcohol-related-liver-disease/#1507302760988-870375fd-f7al. Accessed Oct. 21, 2018.
  4. What is a standard drink? National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Accessed Oct. 22, 2018.
  5. Mellinger JL, et al. Transplantation for alcohol-related liver disease: Is it fair? Alcohol and Alcoholism. 2018;53:173.
  6. Lee BP, et al. Early liver transplantation for severe alcoholic hepatitis: Moving from controversy to consensus. Current Opinion in Organ Transplantation. 2018;23:229.
  7. 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;226:549.
  8. Im GY, et al. Practical concerns and controversies in the management of alcoholic hepatitis. Gastroenterology & Hepatology. 2016;12:478.
  9. Friedman SL. Management and prognosis of alcoholic hepatitis. https://www.uptodate.com/contents/search. Accessed Oct. 22, 2018.
  10. Rethinking drinking: Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism.https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Default.aspx. Accessed Oct. 22, 2018.