Alcoholic liver disease

Abstinence from alcohol

Treatment for alcoholic liver disease involves stopping drinking alcohol. This is known as abstinence.

If you have alcoholic fatty liver disease, you may be able to resume moderate drinking after two weeks of abstinence.

In the case of alcoholic hepatitis, life-long abstinence from alcohol is recommended.

For cirrhosis, life-long abstinence is essential to prevent you from dying of liver failure.

An estimated 70% of people with alcoholic liver disease have an alcohol dependency problem. These people need additional support and advice to help them stop drinking.

People with a dependence on alcohol can find attending self-help groups useful. The most famous one is Alcoholics Anonymous.

Medication is available to help people abstain from alcohol. Disulfiram (sold under the brand name Antabuse) can be used if you are trying to abstain but are concerned that you may relapse, or have relapsed in the past.

Disulfiram causes you to have extremely unpleasant physical reactions if you drink any alcohol, including:

• nausea,
• chest pain,
• vomiting, and
• dizziness.

These reactions should deter you from drinking any more alcohol.

For more information and advice on abstaining from alcohol, see the section on Treatment for alcohol misuse.

Nutritional therapy

Nutritional therapy is another important part of treatment for alcoholic liver disease.

This is because most people with alcoholic liver disease are also malnourished, due to a combination of factors:

• people who drink heavily usually have poor diets,
• many people with alcoholic liver disease experience a loss of appetite, and
• loss of normal liver function can interfere with the production of bile, a type of fluid produced in the liver which digests many important nutrients.

Research has also found that being malnourished makes the liver more vulnerable to the harmful effects of alcohol.

A high-calorie diet that contains plenty of protein and carbohydrates is usually recommended for people with alcoholic liver disease. You may also be told to take mineral and vitamin supplements.

Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian.

In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tube that is inserted directly into your stomach.

Medication

The use of medication in the treatment of alcoholic liver disease is controversial. Many experts have argued that there is limited evidence of its effectiveness.

With severe alcoholic hepatitis, corticosteroid medications may be used to reduce inflammation of the liver.

A number of medications have been used to treat cirrhosis, including:

• anabolic steroids (a more powerful type of steroid medication),
• propylthiouracil (a type of medicine originally designed to treat overactive thyroid glands), and
• colchicine (a medication originally designed to treat gout).

There is a lack of good-quality evidence that these medications are effective in treating alcoholic liver disease.

Liver transplants

In the most serious cases of cirrhosis, the liver loses its ability to function and liver failure occurs. Once liver failure has occurred, it is usually possible to sustain life for several years using medication. However, a liver transplant is currently the only way to cure liver failure.

Most transplant centres expect you to commit to not drinking alcohol for the rest of your life. You usually have to abstain from drinking alcohol for at least three months before you are considered suitable for a transplant.