Alcohol-Induced (Alcoholic) Hepatitis

Overview

What is alcoholic hepatitis?

Hepatitis is inflammation of your liver. It’s a sign of infection or injury to your tissues. Several things can cause hepatitis, including viruses and toxins. Heavy alcohol use is also one of them. Acute alcohol-induced hepatitis might only be a temporary response to overindulgence. But when alcoholic hepatitis becomes a chronic condition, it threatens to do permanent damage to your liver.

How can alcohol use cause hepatitis?

Every food and drink you consume passes through your liver for processing. Your liver helps metabolize nutrients and filters out toxins. When alcohol goes to your liver for processing, it acts as a toxin. It offers no nutritional value and instead breaks down into poisonous chemicals.

Chronic heavy alcohol use can overload your liver with fat and toxins to process. When your liver can no longer keep up, these toxins and fat build up and begin to injure your liver. The injury produces an inflammatory response. This is your body’s way of attempting to heal and ward off further injury.

Like a fever, inflammation is supposed to be a temporary intervention. But when the assault is constant, the inflammation becomes constant. In your liver, this means swelling with fluid. If the swelling is severe and persistent, over time it will damage the tissues, causing cell death.

What is the difference: alcohol-induced hepatitis vs. cirrhosis?

Cirrhosis is late-stage liver disease. It’s what happens when chronic inflammation (hepatitis) does cumulative damage to your liver over time. As cells in the inflamed tissues die, they're gradually replaced with scar tissue. When a significant portion of your liver tissue has become scar tissue, that's cirrhosis. In Western societies, alcohol-induced hepatitis causes 50% of cirrhosis cases.

Cirrhosis will eventually stop your liver from working properly. As scar tissue replaces healthy tissue in your liver, it blocks the flow of blood and slows your liver’s ability to process nutrients and filter toxins. This leads to many complications, including malnutrition, blood toxicity, liver failure and death. In the West, alcohol-induced liver disease causes 80% of liver toxicity deaths.

Who can get alcohol-induced hepatitis (formerly known as alcoholic hepatitis)?

You're more at risk if you use alcohol heavily over many years. But not everyone who gets alcohol-induced hepatitis fits this profile. Some people are more sensitive to alcohol, and their livers react to even moderate use. Others may be able to drink more without inducing hepatitis.

Genetic differences may partially explain this. You may be more at risk if you have a family history of alcohol use disorder or liver disease. Sex differences also play a part. In general, people who were assigned male at birth can tolerate more alcohol than those who were assigned female at birth.

However, everyone is different, and medically we can’t say what a “safe” amount of alcohol is. Some people develop alcohol-associated hepatitis and cirrhosis from seemingly insignificant quantities of alcohol.

Symptoms and Causes

What are the signs and symptoms of alcohol-induced hepatitis?

If you only have mild or early hepatitis, you might not have any symptoms. As the disease progresses, you may begin to notice:

When severe hepatitis has begun to interfere with your liver’s functioning, you may begin to notice signs of these complications, such as:

How much do you have to drink to get alcohol-induced hepatitis?

There’s no single formula that leads to alcohol-induced hepatitis in everybody. But statistically, you’re more at risk if you drink heavily on a regular basis for an extended period of time. Heavy drinking means different things for people assigned male at birth and people assigned female at birth. For (assigned) males, it’s about four standard drinks a day or more than 14 drinks per week. For (assigned) females, it’s about three drinks per day or more than seven drinks per week.

Heavy drinking can also look like occasional binge drinking — more than five drinks in a night for (assigned) males or four for (assigned) females. Binge drinking at least five times a month is considered heavy. If you keep up this pace for as few as six months, your risk of developing alcohol-induced hepatitis rises significantly. Most people have been drinking for five years or more, with periods of abstinence.

Is alcohol-induced hepatitis contagious?

No. Alcohol-induced hepatitis isn't viral, as other types of hepatitis are. You can’t pass the disease on to others in the same way that you might pass on a virus. However, chronic heavy drinking can be “viral” in the social sense. When friends or family binge drink together, they reinforce in each other the behavior that can lead to alcohol-induced hepatitis.

Diagnosis and Tests

How is alcohol-induced hepatitis diagnosed?

Your healthcare provider will begin by asking about your health history, including alcohol use. If they suspect an alcohol use disorder, they'll examine you for signs of related organ damage. This may involve several tests, including:

  • Blood tests. A complete blood count (CBC) screens for a variety of disorders, while liver function tests check specifically for elevated liver enzymes. Blood and urine alcohol screens, such as phosphatidylethanol and urine ethylglucuronide, are becoming more common.
  • Imaging tests to visualize your liver and look for signs of inflammation and damage, such as an ultrasound, fibroscan (where available), CT scan or MRI.
  • Liver biopsy. Your healthcare provider may need to examine a sample of your liver tissue in the lab. They’ll take the sample through a hollow needle inserted into your liver.

Management and Treatment

How is alcohol-induced hepatitis treated?

There’s no medicine to treat alcohol-induced hepatitis directly. The only effective treatment is to quit drinking. But it’s best to quit under medical supervision. Quitting cold turkey can lead to withdrawal symptoms and dangerous side effects.

Your healthcare provider can offer supportive care while you recover from alcohol withdrawal and refer you to further resources to help treat alcohol addiction. They can also help treat some of the complications of alcohol use and hepatitis.

Supplemental treatments may include:

  • Nutritional therapy. Both alcohol use and liver damage can cause malnutrition, due to appetite suppression, nausea and a reduced ability to metabolize nutrients. Malnutrition can contribute to poor recovery from these diseases. Your healthcare provider may prescribe dietary changes and nutritional supplements to help you recover, and sometimes appetite stimulants. In severe cases, they may treat you with enteral nutrition (tube feeding) while you’re in the hospital.
  • Short-term steroids. Healthcare providers may treat certain severe cases of alcohol-induced hepatitis temporarily with steroids to help reduce inflammation and encourage liver cells to regenerate.

Outlook / Prognosis

Can alcohol-induced hepatitis be reversed?

If it’s not too far advanced, alcohol-induced hepatitis can be reversed by quitting alcohol. Those who don’t quit will continue to progress toward cirrhosis and liver failure. Existing scar tissue in your liver can’t be reversed, but you can still prevent further damage and preserve the rest of your liver by quitting. You have to quit completely, and forever, but you can recover.

How long does it take to recover from alcohol-induced hepatitis?

People who quit drinking alcohol after diagnosis show great improvement after six to 12 months. Milder cases often resolve completely. More severe cases can continue to show gradual improvement over the following years. Some livers may bear permanent scarring, but as long as you avoid alcohol, there won’t be ongoing damage.

How long can you live with alcohol-induced hepatitis?

If you don’t stop drinking after diagnosis, you have a reduced life expectancy. For (assigned) males in this group, the five-year survival rate is about 70%. For (assigned) females, it’s 30%. People with severe alcohol-induced hepatitis and advanced liver disease have poorer outcomes. Up to 40% of people with severe alcohol-induced hepatitis die within six months of diagnosis.

A note from Cleveland Clinic

Alcohol-induced hepatitis begins quietly, often without symptoms. Many people fail to recognize the damage that chronic heavy drinking may be doing to their livers. But early recognition is your best hope of catching and reversing the effects of alcohol-induced hepatitis. If you have a history of heavy alcohol use and/or symptoms of liver disease, call your healthcare provider. They’ll check out your liver, assess any possible damage and help you change your habits to change your health future.

Last reviewed by a Cleveland Clinic medical professional on 04/17/2022.

References

  • Basra G, Basra S, Parupudi S. Symptoms and signs of acute alcoholic hepatitis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124878/) World J Hepatol. 2011;3(5):118-120. Accessed 4/17/2022.
  • Heuman D. Alcoholic Hepatitis. (https://emedicine.medscape.com/article/170539-overview%23a6) Accessed 4/17/2022.
  • National Health Services. Alcohol-related liver disease. (https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/) Accessed 4/17/2022.
  • Shah NJ, Royer A, John S. Alcoholic Hepatitis. (https://www.ncbi.nlm.nih.gov/books/NBK470217/) [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 4/17/2022.

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