Alcohol-related liver disease 

Introduction 

Liver disease

Alcohol-related liver disease is a range of conditions and associated symptoms that develop when the liver becomes damaged due to alcohol misuse. In this video, consultant hepatologist Mark Wright talks about how avoiding alcohol can help those with the condition.

Media last reviewed: 19/07/2014

Next review due: 19/07/2016

Image of the liver

The risks of drinking too much

You don't have to be an alcoholic to risk damaging your health. Regularly drinking just above recommended levels can be harmful

Alcohol-related liver disease (ARLD) refers to liver damage caused by alcohol misuse. It covers a range of conditions and associated symptoms.

ARLD does not usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include:

  • feeling sick
  • weight loss
  • loss of appetite
  • yellowing of the eyes and skin (jaundice)
  • swelling in the ankles and tummy
  • confusion or drowsiness
  • vomiting blood or passing blood in your stools

This means that alcohol-related liver disease is frequently diagnosed during tests for other conditions.

If you consistently or intermittently drink alcohol to excess you should tell your GP so they can check if your liver is damaged.

Read more about the symptoms of alcohol-related liver disease and diagnosing alcohol-related liver disease.

Alcohol and the liver

With the exception of the brain, the liver is the most complex organ in the body. It's functions include:

  • filtering toxins from the blood
  • aiding digestion of food
  • regulating blood sugar and cholesterol levels
  • helping to fight infection and disease

The liver is very resilient and is capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse over many years can reduce your liver’s ability to regenerate, resulting in serious damage to the liver.

ARLD is widespread in the UK, and the number of people with the condition has been increasing over the last few decades because of increasing levels of alcohol misuse.

Read more about the causes of alcohol-related liver disease.

Stages of alcohol-related liver disease

There are three main stages of ARLD, although there is often an overlap between each stage. These stages are explained below.

Alcoholic fatty liver disease

Drinking a large amount of alcohol, even for only a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and it's the first stage of ARLD.

Fatty liver disease rarely causes any symptoms but it is an important warning sign that you are drinking at a level harmful to your health.

Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.

Alcoholic hepatitis

Alcoholic hepatitis (not related to infectious hepatitis) is often the second, more serious stage of ARLD. It occurs when alcohol misuse over a longer period causes the tissues of the liver to become inflamed. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).

The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.

Severe alcoholic hepatitis, however, is a serious and life-threatening illness. Many people die from the condition each year in the UK. Unfortunately, some people will only find out they have liver damage for the first time when their condition reaches this stage.

Cirrhosis

Cirrhosis is the final stage of alcohol-related liver disease, which occurs when the liver becomes significantly scarred. Cirrhosis is generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.

If you have alcohol-related cirrhosis and you do not stop drinking, you have a less than 50% chance of living for at least five more years.

How alcohol-related liver disease is treated

There is currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This will prevent further damage to your liver and in some cases can allow your liver to repair itself.

If you are dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available to help you through local alcohol support services

In severe cases, where the liver has stopped functioning despite being completely abstinent from alcohol, a liver transplant may be required. You will only be considered for a liver transplant if you have developed complications of cirrhosis despite abstinence from alcohol. You will also need to remain abstinent from alcohol while awaiting the transplant and for the rest of your life afterwards.

Read more about treating alcohol-related liver disease.

Complications

Death rates linked to ARLD have risen considerably over the last few decades and alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure.

Life-threatening complications of ARLD can develop. These include internal (variceal) bleeding, a build-up of toxins in the brain (encephalopathy), fluid accumulation in the abdomen (ascites) with associated kidney failure and also liver cancer.

Read more about the complications of alcohol-related liver disease.

Preventing alcohol-related liver disease

The most effective way to prevent ARLD is to stop drinking alcohol, or stick to the recommended daily limits and have at least two alcohol-free days a week.

The recommended limits of alcohol consumption are:

  • Men should not regularly drink more than 3-4 units of alcohol a day.
  • Women should not regularly drink more than 2-3 units a day.

A unit of alcohol is equal to about half a pint of normal strength lager or a pub measure (25ml) of spirits. You can use the drinking self-assessment tool to work out whether you're drinking too much.

Even if you have been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and your overall health.

See drinking and alcohol for more information and advice.

Page last reviewed: 06/09/2013

Next review due: 06/09/2015

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Comments

The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

montysdad said on 29 August 2013

This is a good website and it is true that basically everyone who has more than the daily amount has fatty liver- an indicator of hepatic stress.

I personally have a very nervous and anxious disposition and have suffered a few related health problems such a Psychogenic Non-epileptic seizures, depression, acid reflux, high blood pressure etc. As a result I have to admit I have used alcohol to an increasing degree over the years to mask my disquieting thoughts when I am not at work. I am not alcoholic but I drink far too regularly and in high quantities. I can't drink beer as I don't like the volume, but often I will have a glass of red wine while I am making tea, then I'll have another with it. Usually i will then have 2 whiskey and dry gingers following that over the course of an evening.

I never used to drink this much, i regarded it as a treat and had a large single malt collection that I enjoyed in moderation on occasion but I realised that I now don't appreciate it. Alcohol is too freely available and to an extent you can use it to make the worries of life temporarily fade. Unfortunately I think that this is why there is so much drinking related health issues, life is so stressful today.

Anyway I had a baby boy in January who I love dearly with all my soul. I learnt a month later that my employment was ending, my father in law had cancer and my father was heamorraging in hospital. Not only that I started suffering with an awful back problem. I have realised that I have gone over the top with alcohol using it as a crutch to keep going, some mornings before work waking with a hangover. I have to stop!

The earlier you stop and admit you have problem the better. I think if you have trouble remebering the last day you didn't have any alcohol you have a problem that needs addressing.

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barry0675 said on 19 July 2012

we need to act on this the goverment try to ban smoking they have baned drugs why dont the act on drink it kill just as much as smoke and courses more violance behaviour and couses death to others

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Drinking and alcohol

Calculate your units, read about the health risks of drinking too much and find out where to get help and support