Alcohol-Associated Liver Disease

What is alcohol-associated liver disease?

Alcohol-associated liver disease happens when heavy alcohol use causes fat (steatosis) to build up and damage your liver. It’s a type of steatotic (fatty) liver disease. Healthcare providers previously called this condition alcoholic liver disease.

There are three stages or types of alcohol-associated liver disease:

• Alcoholic-associated steatotic liver disease. This is fat buildup in your liver. It happens when you regularly consume more alcohol than your liver can process.
• Alcoholic-associated hepatic steatosis. This happens when excess fat in your liver causes inflammation. Inflammation in your liver can cause severe liver damage and cirrhosis.
• Alcoholic-associated cirrhosis. This is scarring that does permanent damage to your liver.

Symptoms of alcohol-associated liver disease

You can have this condition without symptoms. Often, fatigue is the first symptom. Later, you may have:

• Fever
• Fluid buildup in your belly (ascites) or ankles (edema)
• Loss of appetite
• Vomiting or vomiting blood
• Yellowing of eyes and skin (jaundice)
• Weight loss

Alcohol-associated liver disease cause

You can develop this condition if you drink large amounts of alcohol (heavy alcohol use). Most people who have alcohol-associated liver disease develop it after five to 10 years of heavy alcohol use. The definition of heavy alcohol use is different depending on sex:

• Heavy drinking in males is when you drink three or more drinks a day or 21 or more drinks a week. This usually refers to beer, which has less alcohol concentration than wine, vodka or whiskey.
• Heavy drinking in females is when you drink two or more drinks daily or 14 or more drinks a week.

Research shows 90% of people who have heavy alcohol use (heavy drinkers) develop steatosis (excess fat in their livers). This fat is toxic to the liver and can lead to inflammation, cirrhosis and liver cancer. Fewer people develop more serious forms of alcohol-associated liver disease.

Risk factors

The most significant risk factor is having alcohol use disorder (AUD), meaning drinking heavily on a regular basis for at least five years. Binge drinking can also lead to alcohol-associated liver disease. Alcohol can do more damage to your liver if you have an underlying liver disease.

Complications of alcohol-associated liver disease

Alcohol-associated cirrhosis can lead to life-threatening complications like:

• Gastrointestinal varices or gastrointestinal bleeding, like vomiting blood
• Hepatic encephalopathy of confusion and sleepiness during the day, even coma
• Hepatocellular carcinoma, or liver cancer
• Kidney failure (hepatorenal syndrome)
• Respiratory failure (hepatopulmonary syndrome)
• Spontaneous bacterial peritonitis or infection in the abdomen

How doctors diagnose alcohol-associated liver damage

A healthcare provider will do a physical exam. They’ll ask about your health history. They may ask how much alcohol you drink. That question may make you feel uncomfortable. You may be reluctant to discuss your drinking habits. But understanding how much alcohol you drink helps your provider make a diagnosis.

Your provider may do the following tests:

• Complete blood count (CBC) to check for anemia or low platelet counts
• CT scan, MRI test or ultrasound
• Liver function tests
• Alcohol biomarkers that can detect alcohol in your blood or urine

Tests vary, but some blood alcohol biomarkers can detect heavy alcohol use up to months after you use alcohol.

What is the treatment for alcohol-associated liver disease?

Quitting alcohol is the most common treatment for alcohol-associated steaotic liver disease or alcohol-associated steaotic hepatitis. That treatment can reverse liver damage to your liver.

This may sound like a simple solution. But alcohol-associated liver disease often affects people who have alcohol use disorder (AUD). If you have AUD, your healthcare provider may recommend treatment like:

• Behavioral treatment. You may work with addiction counselors or psychologists. They’ll help you change your drinking behavior.
• Medication. There are medications that can ease the feeling that you need to have a drink.

Treatment for alcohol-associated cirrhosis depends on your health. For example, a liver transplant is the only cure for cirrhosis. But not everyone who needs a healthy liver is able to get one. If you have cirrhosis, ask your healthcare provider if a liver transplant is an option.

When should I see my healthcare provider?

You may want to talk to a provider if you think you’re drinking too much alcohol too often. Your provider knows it’s not always easy to share personal information like alcohol use. They’ll discuss your concerns without making judgements about your situation and check your health.

You might want to ask your healthcare provider the following questions:

• Is my condition reversible?
• Will my condition get worse?
• Are there medications I should avoid because I have alcohol-associated liver disease?

What can I expect if I have alcohol-associated liver disease?

Everyone’s situation is different. Alcohol-associated steatotic liver disease may go away six weeks after you stop drinking alcohol. Things are different if you have cirrhosis. Quitting alcohol can keep it from getting worse. But a liver transplant is the only treatment.

What is the life expectancy for someone who has alcohol-associated liver disease?

Someone with a mild form of this condition may live as long as someone without the condition. But that depends on quitting alcohol. The life expectancy for someone with cirrhosis is shorter. You may live for two to 15 years after your diagnosis. If you have a type of alcohol-associated liver disease, your healthcare provider is your best source of information. That’s because they know the type of alcohol-associated liver disease you have and how the condition affects you.