Complications of alcohol-related liver disease 

There are a number of serious complications that can develop if you have alcohol-related liver disease (ARLD).

Some of the main complications associated with the condition are described below.

Portal hypertension and varices

Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis. It occurs when the blood pressure inside your liver has risen to a potentially serious level.

When the liver becomes severely scarred it is harder for blood to move through it. This leads to an increase in blood pressure.

The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices.

If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing the walls of the varices to split and bleed.

This can cause long-term bleeding, which can lead to anaemia (a condition where the body does not have enough oxygen-carrying red blood cells).

Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like.

Split varices can be treated using an endoscope (a narrow tube with a camera at the end that is passed down into the stomach) to locate the varices. A tiny band can then be used to seal the base of the varices.


If you have portal hypertension, you may also develop a build-up of fluid in your abdomen (tummy) and around your intestines. This fluid is known an ascites.

Initially this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build-up and this will need to be drained. This is a procedure known as paracentesis and involves a long thin tube being placed into the fluid through the skin under local anaesthetic.

One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. 

Hepatic encephalopathy

One of the most important functions of the liver is to remove toxins from your blood. If your liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in your blood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy.

Symptoms of hepatic encephalopathy include:

  • agitation
  • confusion
  • disorientation
  • muscle stiffness
  • muscle tremors
  • difficulty speaking
  • in very serious cases, coma

Hepatic encephalopathy may require admission to hospital. In hospital, body functions are supported while medication is given to remove toxins from the blood.

Liver cancer

Damage to the liver due to heavy drinking over many years can also increase your risk of developing liver cancer.

Over the past few decades, rates of liver cancer in the UK have risen sharply as a result of increased levels of alcohol misuse and it's estimated that 3-5% of people with cirrhosis will develop liver cancer every year.

Page last reviewed: 06/09/2013

Next review due: 06/09/2015