Alcohol-related hepatitis is a liver condition that results from high alcohol consumption. Processing large amounts of alcohol can damage liver cells, leading to swelling and scarring.

The condition can be mild or severe. In severe cases, a person may require a liver transplant if they do not receive treatment or do not stop consuming alcohol during the early stages.

This article explores the relationship between alcohol and the liver, the symptoms and causes of alcohol-related hepatitis, and possible treatment options.

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Alcohol-related hepatitis is a type of alcohol-related liver disease (ARLD). It occurs when a person consumes more alcohol than the liver can process, resulting in inflammation and swelling.

The liver is the second-largest organ in the body. It is on the right side of the torso, under the rib cage. Its main role is to convert foods and drinks into nutrients that the body can use easily.

The liver also filters poisons and harmful substances, including alcohol, from the blood. The liver breaks down alcohol for removal from the body. However, alcohol can damage and destroy liver cells.

Hepatitis, or liver inflammation, is one stage in the progression of ARLD. There are three in total, including:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD): Drinking a large amount of alcohol can lead to fat buildup in the liver, even if a person only does this for a few days. This can lead to MASLD, formerly known as fatty liver disease.
  • Alcohol-related hepatitis: This usually occurs when a person drinks a lot of alcohol over a prolonged period. Less commonly, it can develop after drinking a lot of alcohol in a short time. The inflammation may be reversible if a person stops drinking.
  • Cirrhosis: At this stage, the liver has significant scarring that is typically irreversible. However, stopping drinking can prevent further scarring and prolong a person’s life.

Some people progress through all of these stages in sequence, but not everyone does.

Alcohol-related hepatitis causes the rapid development of symptoms within 60 days of heavy alcohol consumption. Mild cases may cause:

  • malaise, or a general feeling of being unwell
  • abdominal pain and tenderness on the upper-right side
  • fever

The symptoms may flare up after alcohol consumption and go away if a person avoids alcohol. More severe cases may cause:

  • jaundice, or yellowing of the skin and eyes
  • abdominal swelling
  • altered levels of consciousness
  • problems with blood clotting, which may lead to excessive bleeding

If a person has cirrhosis, they may also present with:

  • a loss of muscle mass
  • the development of breast tissue
  • spider angiomas, which are spider-like blood vessels that appear on the skin
  • gastrointestinal bleeding
  • confusion

Some people may not show symptoms until the disease reaches a severe stage. Severe alcohol-induced hepatitis can occur without warning and may lead to life threatening complications, such as liver failure.

The main cause of alcohol-related hepatitis is heavy drinking over an extended period of time. The process of breaking down alcohol in the liver causes inflammation that can destroy liver cells.

Factors that may raise the risk of a person developing the condition include:

  • having other types of hepatitis, such as a hepatitis C infection
  • malnutrition, which can occur in people who drink significant amounts of alcohol, as it can suppress the appetite
  • genetics
  • obesity
  • being female, as alcohol affects the sexes differently

To diagnose alcohol-related hepatitis, a doctor will:

  • take a complete medical history
  • carry out a physical examination
  • ask the person about their history of alcohol consumption and their drinking habits

They may recommend blood tests such as:

  • liver function studies
  • cellular blood counts
  • measuring bleeding times
  • electrolyte tests
  • tests for other chemicals in the body

An ultrasound, CT scan, or MRI scan can show a more detailed view of the liver and any physical damage.

If other tests do not provide a clear answer, the doctor may conduct a liver biopsy. This involves taking a small tissue sample from the liver using a needle or through surgery for testing in a laboratory.

It is possible to reverse alcohol-related hepatitis in the earlier stages by ceasing to drink alcohol. In more advanced cases, stopping drinking can still help to prevent the condition from progressing.

If a person has a dependence on alcohol, they should seek medical advice before stopping drinking. Quitting “cold turkey” can be dangerous for people who drink heavily due to the effects of withdrawal. A doctor can advise on safe ways to do it and provide support if someone has difficulty quitting.

Other treatments aim to reduce or eliminate symptoms, stop the progression of the disease, and restore liver function as much as possible. Some options may include:

  • Dietary changes: A doctor may recommend dietary changes. Vitamin supplements or a focused diet plan may help to correct the balance of nutrients in the body if a person has malnutrition after regular alcohol use.
  • Medication: Doctors may prescribe medications, including corticosteroids and pentoxifylline, to help reduce liver inflammation.
  • Liver transplant: In severe cases, a liver transplant may be the only chance for survival. However, the process of finding a donor can be long and complicated.

A doctor may also suggest lifestyle changes that can help promote or protect liver health. This may include:

  • maintaining a healthy weight
  • getting regular exercise
  • avoiding toxins and illegal drugs
  • receiving vaccinations
  • using a condom or other barrier method during sex to prevent sexually transmitted infections
  • never sharing needles with others

Treatment programs and support

Doctors may recommend alcohol treatment programs for people who find it difficult to cut out alcohol. Programs are available both in and out of hospital settings, depending on the severity of the dependence.

These programs can help people reduce and eventually stop consuming alcohol. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) website can help people locate their nearest treatment program or alcohol cessation specialist.

Help is available

Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.

If you believe that you or someone close to you is showing signs of addiction, you can contact the following organizations for immediate help and advice:

Alcohol-related hepatitis can result in severe and lasting liver damage or cirrhosis, which can lead to serious health complications. These include:

  • Internal, or variceal, bleeding: Damage to the liver may raise blood pressure in the portal vein, causing portal hypertension. Due to scarring, the liver is unable to filter blood in the body effectively. This increases blood pressure, putting extra strain on blood vessels. It may cause blood to go through other, thinner blood vessels. This can cause veins to swell and bleed, and can result in esophageal varices and internal bleeding.
  • Malnutrition: Nutritional issues are common with alcohol-related hepatitis, as symptoms can affect appetite, and limited liver function can affect the absorption of food.
  • Ascites: This refers to a buildup of fluid in the abdomen that can occur when the liver is not working properly. As the fluid accumulates, it can cause discomfort and difficulty breathing.
  • Infections: People may also experience infections. For example, people may experience peritonitis, which refers to an infection of ascitic fluid. Without prompt treatment, this can lead to septic shock.
  • Hepatic encephalopathy: This describes inflammation and a decline in brain function due to toxins in the blood. When the liver is unable to remove toxins from the bloodstream, they can enter the brain and damage brain cells. This can result in brain injury and lead to a coma.
  • Liver cancer: Alcohol is a group 1 carcinogen. Excessive alcohol consumption can increase the risk of liver cancer.
  • Organ failure: In addition to damaging the liver, alcohol-related hepatitis can also affect blood flow to the kidneys. This is known as hepatorenal syndrome. Without treatment, these organs may fail.

The best way to prevent alcohol-related hepatitis is to avoid or limit alcohol consumption.

Not everyone who consumes large amounts of alcohol will develop alcohol-related hepatitis, but because the effects of alcohol can be so variable, it is advisable for those who consume alcohol to do so safely and in moderation.

It is important to note that alcohol-related hepatitis may still be possible in people who drink moderately, although the risk is far lower.

If a person stops drinking early, it is possible to reverse some or all liver damage from alcohol-related hepatitis. This can happen within a few months.

The long-term outlook for an individual with no scar tissue in the liver is positive. However, the outlook worsens if they continue to drink excessively, if they have scarring of the liver, or both.

As such, it is advisable for people with the condition to stop drinking completely to improve their outlook.

Alcohol-related hepatitis is a liver condition that occurs due to heavy alcohol use on a regular basis. Without treatment and the cessation of alcohol consumption, it may eventually lead to irreversible liver scarring, or cirrhosis.

However, hepatitis due to alcohol is reversible in the early stages. Within months of stopping alcohol, the liver may heal.

Other treatments may also help to reduce symptoms, minimize inflammation, and restore liver function. If liver damage is extensive, though, a transplant may be necessary.