Guidelines developed for management of alcohol-associated liver disease


People who keep drinking alcohol have a high risk of serious liver damage and death. In people with liver failure, the liver completely ceases to function. This can be an outcome of advanced-stage liver disease and often means that a liver transplant is the only option for prolonged survival. A liver transplant is a complicated procedure that depends on a donor’s availability.

Heavy ethanol consumption produces a wide spectrum of hepatic lesions, the most characteristic being fatty liver (i.e., steatosis), hepatitis, and fibrosis/cirrhosis (see figure 2). Steatosis is the earliest, most common response that develops in more than 90 percent of problem drinkers who consume 4 to 5 standard drinks per day over decades (Ishak et al. 1991; Lieber 2004). (A standard drink is defined as the amount of alcoholic beverage that contains approximately 0.5 fluid ounces, or about 14 grams, of pure alcohol [figure 3]). However, steatosis also develops after binge drinking, defined as the consumption of 4 to 5 drinks in 2 hours or less.

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For the optimal assessment of liver fibrosis, it must be appreciated by specific stains, as Masson Trichrome or Sirius Red. The liver is your largest internal organ, about the size of a football. It’s located mainly in the upper right portion of your abdomen, under the diaphragm and above your stomach.

More advanced disease is characterized by marked steatosis, hepatocellular necrosis, and acute inflammation, known as alcoholic hepatitis. There is a need for more effective treatment of alcoholic liver disease as the severe form of the disease is life-threatening. This activity reviews the evaluation and management of alcoholic liver disease and highlights the role of the interprofessional team in the recognition and management of this condition. Alcoholic liver disease is caused by excessive consumption of alcohol. There are three stages—alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis. SREBP-1c belongs to a family of transcription factors that control hepatic cholesterol metabolism.

Lifestyle changes

Blood tests can detect liver damage before it progresses too far to heal on its own, but since the early stages of damage don’t typically cause symptoms, patients who don’t have regular checkups wouldn’t know to ask for the tests. Alcohol doesn’t just affect the mind; it also affects the body. It is needed for hundreds of bodily processes, including breaking down toxins such as alcohol.

alcohol related liver disease

Alcoholic hepatitis, which is unrelated to infectious hepatitis, is a potentially serious condition that can be caused by alcohol misuse over a longer period. After stopping drinking, which is the first step in any treatment of ALD, an assessment will be made as to the extent of the damage and the overall state of the body. Treatment also consists of evaluation for other risk factors that can damage the liver or put the liver at higher risk, such as infection with hepatitis C and metabolic syndrome. In compensated cirrhosis, the liver remains functioning, and many people have no symptoms. The median life expectancy from this point is 10 to 12 years.


Once damage begins, it can take a long time to become noticeable, as the liver is generally highly effective at regenerating and repairing itself. Often, by the time doctors detect the damage, it is irreversible. The best treatment for ALD, regardless of the stage of the disease, is abstinence from alcohol. If you’re struggling with alcohol abuse, contact our helpline to speak with one of our healthcare specialists today. If you notice early signs of liver problems, contact your doctor immediately.

  • Medications and lifestyle modifications may also be prescribed depending on the stage.
  • “This subclassification acknowledges the frequent coexistence and synergism of metabolic risk and alcohol use, viewing them more as a spectrum than mutually exclusive conditions,” he wrote.
  • When liver damage has happened due to alcohol, it’s called alcohol-related liver disease.
  • Recently, new biomarkers are developed that can non-invasively estimate the degree of alcohol intake and alcohol-induced liver damage.

Also, the damage caused by alcohol can interfere with the absorption and processing of nutrients. People may have deficiencies of folate, thiamin, other vitamins, or minerals. Deficiencies of certain minerals can cause weakness and shaking. Obesity makes people more vulnerable to liver damage by alcohol. Rarely, patients with hepatic steatosis or cirrhosis present with Zieve syndrome (hyperlipidemia, hemolytic anemia, and jaundice). In one third of patients, the liver is enlarged and smooth, but it is not usually tender.

Current Management of ALD

The process of metabolizing alcohol can result in the production of substances that damage liver cells. It can also lead to the production of abnormal levels of fats, which are stored in the liver. Finally, alcohol ingestion can also cause liver inflammation and fibrosis (the formation of scar tissue). In its advanced stages, alcohol-related liver disease is a serious, life-threatening condition. In 2019, for instance, alcohol-related liver disease resulted in the death of approximately 37,000 people in the U.S.

  • Patients initially exhibit active pericellular fibrosis, which may progress to cirrhosis, the late stage of hepatic scarring.
  • Hepatocytes also express very high levels of catalase, an enzyme that inhabits peroxisomes.
  • However, when ethanol is present, catalase has an accessory role in ethanol metabolism by using H2O2 to oxidize ethanol to acetaldehyde.
  • In a four-part series published in early January, The Denver Post examined why so many Coloradans are dying, and ways to save lives that the state hasn’t pursued.
  • American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information.
  • The gender-dependent differences in the gastrointestinal and hepatic metabolism of alcohol are likely to contribute towards the increased susceptibility of women to alcohol-induced liver injury [34].

Excessive alcohol consumption is a global healthcare problem with enormous social, economic, and clinical consequences, accounting for 3.3 million deaths in 2012 (World Health Organization 2014). Excessive drinking over decades damages nearly every organ in the body. However, the liver sustains the earliest and the greatest degree of tissue injury from excessive drinking because it is the primary site of ethanol metabolism (Lieber 2000). After a brief overview of alcohol metabolism in the liver, this article will summarize the mechanisms through which excessive alcohol consumption contributes to the development of various types of alcohol-induced liver damage.

Acute Alcohol Hepatitis Patient Advocate – Kenneth

It’s generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. The liver can develop new cells, but prolonged alcohol misuse (drinking too alcoholic liver disease much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver. Corticosteroids are used to treat severe alcoholic hepatitis by decreasing inflammation in the liver.

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