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 (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 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.
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.