Alcoholic Hepatitis

Estimated reading time: 26 minute(s)

Sitting in the right side of the torso behind the ribs, the liver is one of the largest organs in the body. Its primary role is converting food and beverages into nutrients the body can easily absorb and utilize. It also filters harmful toxins and poisons, including alcohol, to eventually excrete it from the body. Ironically, the same alcohol that the liver breaks down and removes can damage the organ, mainly when used excessively for longer durations, leading to a condition called alcoholic hepatitis.

Alcoholic hepatitis describes an inflammatory liver condition triggered by heavy alcohol use for extended durations. As a toxin, alcohol directly targets the liver cells, causing scarring and swelling while decreasing the overall functions associated with the organ. If unmanaged, the condition can rapidly progress and become complicated, leading to serious consequences. Understanding what alcohol hepatitis is, how it develops, and how to treat or prevent is essential to save lives.

Alcoholic Hepatitis Causes and Risk Factors

As mentioned by name, the primary cause of alcoholic hepatitis is heavy drinking for longer durations. The constant process of breaking down heavy amounts of alcohol, more than what the liver can handle, can cause its cells to inflame and eventually get harmed. The liver responds by forming scar tissue to replace these damaged cells, but with time, the scar tissue may also start replacing functional liver tissue. Consequently, the functioning of the liver takes a hit, leading to a host of complications. When the process continues for some time, the scarring becomes irreversible, a stage called cirrhosis. Once cirrhosis develops, it can quickly cause the liver to fail. A failing liver often interferes with the blood flow to the kidneys, perpetuating a cycle of multiorgan failure.

In addition to alcohol, multiple other factors also contribute to the development of alcoholic hepatitis. Hepatitis C alcoholism is one of these causes where a person diagnosed with hepatitis C can end up developing alcoholic hepatitis due to a high risk. To avoid this complication, people with hepatitis C are strictly advised to abstain from alcohol.

Malnutrition is a common element in alcoholic hepatitis. Many people struggling with this disorder also complain of appetite suppression, and alcohol may become the primary source of calories for them, which only worsens malnutrition. This malnutrition can also contribute to the development and progression of alcoholic hepatitis.

Other risk factors associated with alcoholic hepatitis include the following:

  • Individuals assigned female sex at birth are at a higher risk of acquiring alcoholic hepatitis [1]
  • Obesity or high BMI
  • Certain genetic factors, such as history of liver disease in the family
  • Ethnicity and race, as Hispanic and African American people are more likely to develop alcoholic hepatitis [2]

Symptoms of Alcoholic Hepatitis Explained

The symptoms of alcoholic hepatitis can differ, depending on the extent of damage in the liver. People with mild levels of damage may not develop any symptoms until the damage progresses to a more significant stage. When this happens, the following symptoms may occur:

  • Nausea and vomiting
  • Dry mouth
  • Changes in appetite
  • Fever
  • Swelling or pain in the abdomen
  • Jaundice, a condition where eyes and skin turn yellow
  • Weight loss
  • Easy bruising or bleeding
  • Changes in the mental status, confusing

The symptoms of hepatitis may resemble those caused by other health issues. People who develop them must consult a doctor to determine the actual cause and commence treatment immediately.

Diagnosing Alcoholic Hepatitis

People who present with symptoms of alcoholic hepatitis undergo an extensive history-taking session where a healthcare professional asks them about their alcohol consumption and overall health as a whole. They may also investigate to check if there is any free fluid in the abdomen or the liver or spleen enlargement.

To support the diagnosis, the following tests are often performed:

  • Full blood count
  • Blood clotting tests
  • Liver function tests
  • Ultrasound of the liver
  • Abdominal CT scan

In some cases, a liver biopsy may be indicated to confirm the diagnosis. The process involves removing a small tissue sample from the liver and analyzing it under the microscope for any abnormal changes. A liver biopsy is an invasive procedure and comes with certain risks; however, the results can indicate the type and severity of the liver condition very accurately.

Managing Alcoholic Hepatitis

Alcohol can not only cause alcoholic hepatitis but also worsen it. Hence, the first tip to manage this condition is to abstain from alcohol. Quitting drinking can significantly manage symptoms while reducing further damage to the liver. In the early stages of alcoholic hepatitis, abstinence may even reverse the damage. However, when the damage progresses, the condition slowly becomes permanent with no chance of reversibility.

However, this does not mean that people with permanent liver damage can continue drinking with no repercussions. According to research, those with permanent damage to the liver who continue drinking experience a 30 percent decrease in the survival rate compared to those who stop drinking. [3] In addition to abstinence, the following treatment options may also be offered:

  • Medications: In some cases, medications like pentoxifylline may be prescribed to reduce liver inflammation while improving its function. Some studies have also found baclofen effective in helping people with liver disease reduce their drinking habits and maintain sobriety. [4] However, the medication does not have FDA approval to be used for this purpose so far.
  • Nutritional Supplements: People with alcoholic hepatitis are often nutritionally compromised, which only worsens their health. A doctor may recommend using supplements to improve the malnutrition status. If oral intake is not enough, a feeding tube may be passed to supplement the current eating regime through nutrient-rich liquids that go into the digestive system through this tube.
  • Liver Transplant: A transplant becomes necessary when the damage is advanced and irreversible. An abstinence period of at least six months is required to qualify for this process.
  • Counseling: Doctors often recommend counseling as a part of alcoholic hepatitis treatment to support and improve emotional well-being. Moreover, it also helps patients learn new coping skills to manage daily stressors while reducing alcohol cravings.

Why is Alcoholic Hepatitis Treatment Necessary? The Complications Explained

If untreated, alcoholic hepatitis may lead to severe and lasting liver damage, which, in turn, may cause serious complications. Some of these complications may become serious, leading to alcoholic hepatitis death.

Liver Cirrhosis

Cirrhosis occurs when the scar tissue permanently forms instead of the healthy tissue in the liver. This affects the overall liver functions, causing it to fail eventually. Liver cirrhosis also increases the risk of acquiring liver cancer.

Esophageal Bleeding

Excessive scar tissue formed in the liver often slows down the blood flow, increasing the overall blood pressure within the organ while reducing resilience and strength in the surrounding blood vessels of the stomach and esophagus. With excessive pressure buildup, these vessels swell and burst, leading to internal bleeding.


This condition causes fluid to accumulate in the abdomen, making it tender and swollen. The condition can be excruciating and uncomfortable, often interfering with normal breathing.

Spontaneous Bacterial Peritonitis

The fluid that builds up in the abdomen may get infected, leading to spontaneous bacterial peritonitis or SBP. SBP is a medical emergency and warrants immediate treatment to save lives.

Hepatic Encephalopathy

This complication occurs when the toxins normally filtered out by the liver start piling up in the blood due to reduced hepatic function. These toxins eventually reach the brain and cause confusion, irritability, and even coma.

Organ Failure

With time, the damage to the liver may start affecting other organs, such as the kidneys, triggering multiorgan failure.

Other Complications

Other complications of alcoholic hepatitis include the following:

  • Issues with blood clotting
  • High levels of bilirubin
  • Low blood platelet count
  • Infection
  • Iron overload


What is the outlook for alcoholic hepatitis?

The outlook for alcoholic hepatitis is dependent on the following three factors:

  • The extent of damage to the liver
  • The severity of current symptoms
  • Whether a person has stopped drinking

In general, the outlook is good if the symptoms are mild and a person is slowly working on attaining abstinence. In some cases, mild cases may also be reversed if alcohol abstinence is strictly observed. However, continued drinking can worsen the condition and negatively affect the chances of recovery.

Can you prevent developing alcoholic hepatitis?

The best way to prevent developing alcoholic hepatitis is by avoiding alcohol or limiting its use. Less than two drinks per day for men and one drink per day for women is generally considered moderate-level drinking, which is relatively safer for the liver. Additionally, you can also reduce the risk by vaccinating for hepatitis B and hepatitis C, which may spread by sharing needles or through bodily fluids


1 Maddur H, Shah VH. Alcohol and liver function in women. Alcohol research: current reviews. 2020;40(2).

2 Levy RE, Catana AM, Durbin‐Johnson B, Halsted CH, Medici V. Ethnic differences in presentation and severity of alcoholic liver disease. Alcoholism: Clinical and Experimental Research. 2015 Mar;39(3):566-74.

3 Fung P, Pyrsopoulos N. Emerging concepts in alcoholic hepatitis. World journal of hepatology. 2017 Apr 4;9(12):567.

4 Mosoni C, Dionisi T, Vassallo GA, Mirijello A, Tarli C, Antonelli M, Sestito L, Rando MM, Tosoni A, De Cosmo S, Gasbarrini A. Baclofen for the treatment of alcohol use disorder in patients with liver cirrhosis: 10 years after the first evidence. Frontiers in Psychiatry. 2018 Oct 1;9:474.

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