Alcoholic Hepatitis: Causes, Symptoms & Treatment

What is Alcoholic Hepatitis?

Alcoholic hepatitis is an inflammation of the liver caused by excessive consumption of alcohol. It is one of the three main categories of alcoholic liver disease. It is preceded by fatty liver, a less serious and reversible condition that often does not produce any symptoms. If left untreated, alcoholic hepatitis can progress to alcoholic cirrhosis, a life-threatening condition characterized by scarring and decreased function of the liver.

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Risk Factors for Alcoholic Hepatitis

In addition to heavy drinking, the development of alcoholic hepatitis is also dependent on the presence of multiple modifying factors. The risk factors for alcoholic hepatitis include:¹

• Gender
• Genetic predisposition
• Ethnicity
• Obesity
• Underlying or associated liver diseases
• Poor nutritional status
• Binge drinking
• Smoking status

Symptoms of Alcoholic Hepatitis

Alcoholic hepatitis usually develops over many years of heavy drinking, but in some people it can develop very suddenly. However, not all heavy drinkers will develop alcoholic hepatitis and the disease may also occur in people who drink only moderately. The most common symptoms of alcoholic hepatitis include:²

• Abdominal pain
• Yellowing of the skin and eyes (jaundice)
• Enlarged liver (hepatomegaly)
• Tender liver
• Nausea
• Vomiting
• Loss of appetite
• Malnutrition
• Weight loss
• Fatigue
• Fever

Alcoholic hepatitis is a very serious condition. Up to 40% of patients with a severe form of alcoholic hepatitis will die within 6 months after the onset of symptoms.³ People diagnosed with alcoholic hepatitis must stop drinking alcohol immediately, or they face a high risk of serious liver damage and even death.

Treatment Options

In addition to the cessation of alcohol consumption, there are several forms of treatment that have shown modest short-term benefits in treating patients with severe forms of alcoholic hepatitis. These include:

• Glucocorticoid therapy (prednisolone) is a treatment used to reduce inflammation.⁴
• N-acetyl cysteine is an antioxidant that can be administered in combination with glucocorticoid therapy to improve patient survival.⁵
• Pentoxifylline is a medication used to improve kidney function.⁶
• Enteral nutrition is a method of nutritional support that delivers artificially prepared food to the gut (by means such as by tube-feeding) for the reversal of health problems caused by malnutrition.⁴
• Fecal microbiota transplantation is a novel technique for treating the microbial imbalance of the gut associated with alcoholic hepatitis.⁷ Approved clinical trials are currently recruiting participants for studies in which the fecal material from healthy individuals will be transferred to recipients suffering from alcoholic hepatitis.⁸

Liver transplantation may be required for select patients who do not respond to other medical therapies. It is important to note that many liver transplant centers require at least six months of abstinence from alcohol before a patient can become eligible for a transplant.⁹

Any long-term survival from alcoholic hepatitis is dependent on the continued abstinence of alcohol, and this condition is often reversible if the individual quits drinking before any permanent damage is done to the liver. If you or someone you love has been diagnosed with alcoholic hepatitis and are unable to stop drinking, please know that help is available.

Please contact an addiction specialist to learn about alcohol treatment programs that will work best for you. An initial alcohol detox should be completed under professional medical supervision so that any harmful or uncomfortable withdrawal symptoms can be properly addressed. Once detox is completed, you will begin the rehabilitation stage of treatment. You may be treated on an outpatient basis or can be referred to an inpatient residential program. Inpatient alcohol rehab facilities provide around-the-clock care and offer the most structured treatment programs that can include individual and group counseling, family support groups, and behavioral therapy.

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How is Alcoholic Hepatitis Diagnosed?

Diagnosing alcoholic hepatitis is not always simple. Alcoholic hepatitis can vary widely in presentation and can sometimes mimic bacterial infections. Maintaining a thorough history remains one of the best ways to diagnose alcoholic hepatitis. A thorough history may consist of a robust medical history, an evaluation of alcoholic hepatitis related symptoms, and a comprehensive physical examination. Physicians may also conduct labs that will provide clues to a diagnosis of alcoholic hepatitis. Physicians may also conduct liver scans, liver biopsies, nutritional assessments, and more.¹⁰

Sources

1. Philips, C.A., Augustine, P., Yerol, P.K., Rajesh, S., & Mahadevan, P. (2019). Severe alcoholic hepatitis: current perspectives. Hepatic Medicine,11, 97-108.
2. Basra, G., Basra, S., Parupudi, S. (2011). Symptoms and signs of acute alcoholic hepatitis. World Journal of Hepatology, 3(5), 118-20.
3. Lucey, M.R., Mathurin, P., & Morgan, T.R. (2009). Alcoholic hepatitis. New England Journal of Medicine, 360, 2758-2769.
4. Aday, A.W., Mitchell, M.C., & Casey, L.C. (2017). Alcoholic hepatitis: current trends in management. Current Opinion in Gastroenterology, 33(3), 142-148.
5. Nguyen-Khac, E., Thevenot, T., Piquet, M.A., Benferhat, S., Goria, O., Chatelain, D., …& AAH-NAC Study Group. (2011). Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. New England Journal of Medicine, 365(19), 1781-1789.
6. Akriviadis, E., Botla, R., Briggs, W., Han, S., Reynolds, T., & Shakil, O. (2000). Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology, 119(6), 1637-1648.
7. Philips, C.A., Phadke, N., Ganesan, K., Ranade, S., & Augustine, P. (2018). Corticosteroids, nutrition, pentoxifylline, or fecal microbiota transplantation for severe alcoholic hepatitis. Indian Journal of Gastroenterology, 37(3), 215-225.
8. U.S. National Institutes of Health. (2019). Fecal Microbiota Transplantation in Severe Alcoholic Hepatitis- Assessment of Impact on Prognosis and Short-term Outcome.
9. Obed, A., Stern, S., Jarrad, A., & Lorf, T. (2015). Six month abstinence rule for liver transplantation in severe alcoholic liver disease patients. World Journal of Gastroenterology, 21(14), 4423-4426.
10. Amini, M., & Runyon, B. A. (2010). Alcoholic hepatitis 2010: a clinician’s guide to diagnosis and therapy. World journal of gastroenterology, 16(39), 4905–4912.