Alcoholic hepatitis: symptoms, causes and treatment in the UK

Alcohol-related liver disease (ARLD) is liver damage caused by drinking too much alcohol over a long time. The NHS describes three stages: fatty liver, alcohol-related hepatitis and alcohol-related cirrhosis. Alcoholic hepatitis is the middle stage, in which the liver is swollen and damaged.

NHS inform explains that alcoholic hepatitis is unrelated to infectious hepatitis. It is a potentially serious condition that can be caused by alcohol misuse over a longer period, and for some people it may be the first time they become aware they are damaging their liver. Less commonly, it can occur after a large amount of alcohol in a short period, such as binge drinking.

The liver is resilient and able to regenerate. NHS inform notes that each time the liver filters alcohol some cells die and new ones can form, but prolonged heavy drinking over many years can reduce this ability and cause serious, permanent damage.

The NHS says ARLD does not always cause symptoms in the early stages. NHS inform adds that symptoms often do not appear until the liver is badly damaged, which means ARLD is frequently found during tests for other conditions or at an advanced stage.

Because alcoholic hepatitis is the stage at which symptoms are likely, the following become more common as damage increases.

• Feeling very tired, less hungry than usual, losing weight without trying, and feeling or being sick.

• Pain or discomfort in the upper right side of the tummy.

• Yellowing of the skin or whites of the eyes (jaundice), which may be harder to see on black or brown skin.

• A high temperature.

• Swelling of the tummy from fluid, and swollen legs.

• Hands shaking, and problems with confusion, concentration and memory.

• Blood in vomit or poo (poo may look black, and vomit may look like coffee grounds).

The NHS advises getting medical help if you think you might have ARLD and not waiting for symptoms to get worse. See a GP or an alcohol addiction support service if you have symptoms of liver disease, are worried about your drinking or want help to stop.

Call 999 or go to A&E if you are worried alcohol may be affecting your liver and you vomit blood or your poo is black and looks sticky, you have pain in your tummy, you have difficulty breathing or shortness of breath, or you feel suddenly confused, feel dizzy or have difficulty staying awake. The NHS advises not to drive to A&E; ask someone to drive you or call 999.

The NHS says ARLD is caused by regularly drinking too much alcohol, and that anyone can get it. You are more likely to develop it if you drink too much and you already have a liver condition such as hepatitis C, have diabetes (especially type 2), are overweight or obese, or have a family history of alcohol-related diseases and addiction. The NHS also says ARLD develops more quickly and at lower drinking levels in women than in men.

NHS inform adds that genetics play a role, because alcohol dependence and problems processing alcohol often run in families. The NHS recommends drinking no more than 14 units a week, spread across 3 days or more.

To diagnose ARLD, the NHS says a doctor will ask about your drinking and how it is affecting your life, and may arrange tests: blood tests to check liver health, scans such as an ultrasound or CT scan, and sometimes a liver biopsy, which is a small sample taken from the liver.

NHS inform says that if symptoms or liver function tests suggest an advanced form of ARLD, either alcoholic hepatitis or cirrhosis, you may need further tests. Being open about how much you drink helps your clinicians interpret results and choose the right treatment.

The NHS says the aim of treatment is usually to help you stop drinking alcohol completely, and that this is important whatever stage you have. Support may include talking therapies such as CBT, medicines to help you stop drinking safely or reduce cravings, and support groups such as Alcoholics Anonymous.

NHS inform says there is currently no specific medical treatment for ARLD itself: the main treatment is to stop drinking, preferably for the rest of your life, which reduces the risk of further damage and gives the liver the best chance of recovering. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. NHS inform also says that if you have alcohol-related cirrhosis or alcoholic hepatitis and do not stop drinking, no medical or surgical treatment can prevent liver failure.

The NHS says people whose liver is badly damaged may need hospital treatment and may be considered for a liver transplant. NHS inform adds that transplant units require a person not to drink while awaiting the transplant and for the rest of their life.

The NHS says ARLD can be life-threatening and can cause liver failure, fluid build-up in the tummy, internal bleeding, problems with confusion, concentration and memory, liver cancer and kidney damage. NHS inform lists variceal bleeding, build-up of toxins in the brain (encephalopathy) and ascites with associated kidney failure.

The outlook depends greatly on whether drinking stops. The NHS says that if you stop drinking your liver can often recover, while later stages are harder to treat and more likely to have serious complications. The liver damage in mild alcoholic hepatitis is usually reversible if you stop drinking permanently, according to NHS inform.

On the NHS, a GP or alcohol support service is the usual starting point, with referral to hepatology or gastroenterology and specialist alcohol services if needed. Severe alcoholic hepatitis is managed in hospital.

Private hepatology appointments and private alcohol treatment programmes exist and may shorten waits, but the core principle of treatment, stopping drinking with supervised support, is the same. The NHS stresses getting medical help before stopping heavy drinking suddenly, because it can be dangerous. Free NHS and charity support, such as Alcohol Change and SMART Recovery, is listed on the NHS page.