Alcohol-Induced Hepatitis

Alcohol-induced hepatitis is inflammation in your liver caused by heavy alcohol use. It’s sometimes called alcoholic hepatitis. It can sometimes be a short-term reaction to drinking too much alcohol. But in the long term, it can cause permanent damage to your liver. You can develop this even after you stop drinking because alcohol can cause damage to your liver without any symptoms.

How does drinking alcohol cause hepatitis?

All food and drink pass through your liver for processing. Your liver helps metabolize nutrients and filter out toxins. When your liver processes alcohol, it treats it as a toxin. Alcohol doesn’t provide any nutrients. It breaks down into harmful toxins that can cause damage to liver cells.

Chronic drinking, daily drinking or alcohol use disorder can overload your liver with toxins. When your liver can’t keep up, these toxins build up and damage liver cells. The damage causes inflammation. This is your body’s way of trying to heal and protect itself. But when your liver stays inflamed, it damages healthy liver tissue. This leads to scarring (cirrhosis of the liver).

Symptoms of alcohol-induced hepatitis

If you only have mild hepatitis, you might not have any symptoms. As the disease gets worse, you may notice:

• Tenderness or soreness in your upper right abdomen (where your liver is)
• Visibly swollen or enlarged liver
• Swelling in your abdomen
• Loss of appetite and weight loss
• Nausea
• Light-colored poop that floats

When severe hepatitis affects your liver’s functioning, you can have:

• Fever
• Fast heart rate
• Jaundice (yellowing of the whites of your eyes)
• Easy bleeding and bruising (like nosebleeds or rectal bleeding)
• Confusion
• Feeling very tired
• Small, dilated blood vessels on your skin

Alcohol-induced hepatitis causes

Alcohol is toxic to your liver in any amount. But in most cases, your liver can regenerate and repair damage from alcohol. Sometimes, acute or heavy alcohol use can cause alcoholic hepatitis. This can also develop in people who drink a lot of alcohol on a regular basis.

There’s no way to predict who will develop alcoholic hepatitis, and there’s no “safe amount” of alcohol to drink. It’s important to note that you can develop alcoholic hepatitis without having alcohol use disorder. The amount of alcohol you drink isn’t the only factor that determines whether your liver is going to be sick. You’re more at risk if you drink heavily on a regular basis for a long period of time. But this can also develop in people who drink regularly for shorter periods. Heavy alcohol use is defined as more than two drinks a day for males, or 14 drinks per week. For females, it’s more than one drink a day or seven drinks per week.

Heavy drinking can also be occasional binge drinking — more than five drinks in a night for males or four for females. Binge drinking at least five times a month is considered heavy use. If you keep up this pace for as little as six months, your risk of developing this condition increases.

Risk factors for alcohol-induced hepatitis (alcoholic hepatitis)

You’re more at risk if you use alcohol heavily over many years. But not everyone who drinks large amounts of alcohol will get the disease. Some people are more sensitive to alcohol. Their livers react to even moderate alcohol use.

You may be more at risk if you have a family history of alcohol use disorder or liver disease. Females are at a higher risk because it generally takes less alcohol to harm their livers (compared to males).

Research shows that drinking above recommended limits can be harder on your liver if you have a higher body weight.

Complications of alcohol-induced hepatitis

The most serious complication is progression to cirrhosis and liver failure.

Cirrhosis is late-stage liver disease. It’s what happens when hepatitis does permanent damage to your liver. Most of your liver is scar tissue. Cirrhosis will eventually stop your liver from working (liver failure).

As liver damage worsens, scar tissue replaces healthy tissue. This affects your liver’s ability to do its job. It can lead to complications like:

• High pressure in the veins around your liver, called portal hypertension
• Bleeding from veins in your stomach or esophagus
• Confusion or disorientation due to toxin buildup
• Buildup of fluid in your abdomen (ascites)
• Swelling of your legs and testicles (for males)
• Infections
• Kidney problems

How doctors diagnose alcohol-induced hepatitis

Your healthcare provider will begin by asking about your health history. They’ll also ask how often you drink. If they suspect alcohol use disorder, they’ll examine you for signs of organ damage. This may involve tests like:

• Blood tests: A complete blood count (CBC) screens for several disorders. Liver function tests check for elevated liver enzymes.
• Imaging tests: Ultrasound, CT scan or MRI can check your liver and look for signs of inflammation and damage.
• Liver biopsy: Your healthcare provider may need to look at a sample of your liver tissue in a lab. They’ll take the sample through a hollow needle inserted into your liver.

How is it treated?

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. Withdrawal can cause dangerous side effects. Your healthcare provider can offer supportive care while you recover from alcohol withdrawal. They can refer you to resources to help treat alcohol use disorder.

Supplemental treatments may include:

• Nutritional therapy: Liver damage and alcohol use can affect how your body gets and uses nutrients. This can make it harder to recover. Your healthcare provider may recommend dietary changes and nutritional supplements. In severe cases, they may give you nutrients with a feeding tube while you’re in the hospital.
• Short-term steroids: Providers may treat certain severe cases of alcohol-induced hepatitis with steroids. Steroids help reduce inflammation and encourage liver cells to regenerate.

Can alcohol-induced hepatitis be reversed?

When the disease is caught early, quitting alcohol can allow your liver to heal. Continuing to drink increases your risk of cirrhosis and liver failure. Scar tissue in your liver can’t be reversed. But you can prevent damage to healthy tissue. Avoiding alcohol is the best way to keep your liver working as well as possible.

What’s the life expectancy of alcohol-induced hepatitis?

You have a reduced life expectancy if you keep drinking alcohol after diagnosis. For males, the five-year survival rate is about 70%. For females who don’t stop drinking, it’s 30%.

Your life expectancy is shorter if you have severe alcohol-induced hepatitis. Up to 40% may die within six months of diagnosis. Some people with alcoholic hepatitis will need liver transplants.