Can Alcoholic Hepatitis Be Cured?

Alcoholic hepatitis is inflammation of the liver resulting from excessive consumption of alcohol. While alcohol is toxic to all cells in the body, it is particularly toxic to the liver since it is primarily metabolized by the liver. The metabolic byproducts of alcohol trigger an inflammatory response resulting in damage and death of liver cells.

The liver is a complex organ that helps digestion with the bile fluid it produces, regulates blood glucose and cholesterol levels, makes enzymes and proteins that the body needs for healthy functioning, fights infections and diseases, and metabolizes and helps remove toxins including alcohol from the body.

Heavy drinking for even a few days can cause the buildup of fat and lead to fatty liver, which is the earliest stage of alcoholic liver disease. Alcoholic hepatitis can also be caused by drinking large quantities of alcohol in a short time period (binge drinking on weekends, for example).

Drinking in excess of 1-2 standard drinks a day regularly is considered heavy drinking and, over a period of time, can result in alcoholic hepatitis as the liver’s ability to process the alcohol is overwhelmed. Unprocessed toxins damage the liver, build up in blood, and affect other organs as well.

Alcoholic cirrhosis is an advanced stage of alcoholic liver disease, and is irreversible. Cirrhosis results when sustained inflammation destroys healthy, functioning liver cells which are replaced by scar tissue. 

Taking remedial steps for alcoholic hepatitis can help regain significant liver function, but liver damage from cirrhosis is permanent and often leads to liver failure.

Mild alcoholic hepatitis may often cause no significant symptoms. The most common symptoms of alcoholic hepatitis include:

• Loss of appetite
• Nausea and vomiting
• Abdominal pain and tenderness
• Abdominal and ankle swelling
• Jaundice
• Weight loss
• Fever
• Weakness and fatigue
• Confusion and lethargy
• Blood in vomit
• Blood in stools

Complications of alcoholic hepatitis include:

• Variceal hemorrhage: Internal bleeding from small veins dilated (varices) due to portal hypertension. Portal vein carries blood from the digestive organs to the liver and the scar tissue caused by alcoholic hepatitis blocks the blood flow and causes portal hypertension.
• Hepatic encephalopathy: Impairment of brain function from toxin buildup in the blood because the damaged liver is unable to process and eliminate the toxins.
• Coagulopathy and thrombocytopenia: Impaired blood clotting function and low platelet count in blood.
• Ascites: Fluid buildup in the abdominal cavity, caused by portal hypertension and the liver’s inability to produce albumin, a protein which prevents fluid from leaking out of blood vessels.
• Spontaneous bacterial peritonitis: Bacterial infection in the membrane (peritoneum) that lines the abdomen, due to ascites and gastrointestinal bleeding.
• Kidney failure: Dysfunction of blood circulation due to portal hypertension damages the kidney leading to water retention.
• Iron overload: Excessive iron getting deposited in the liver causing further damage.
• Infections: Damage to the liver compromises immunity and increases vulnerability to infections.
• Hepatitis C: Common in patients with alcoholic hepatitis, likely because intoxication impairs judgement and leads to risky behavior.  Hepatitis C infection hastens the progression to liver cirrhosis and liver failure.
• Liver cancer: Liver damage increases the risk for developing liver cancer.

A history of heavy alcohol consumption and presence of physical symptoms are usually clear indicators of alcoholic hepatitis. Patients tend to minimize the extent of their alcohol intake; as a result, their doctor may ask for a detailed history and talk to the family, with the patient’s consent.

Tests used to diagnose alcoholic hepatitis include:

• Blood tests such as:
  • Liver function tests
  • Complete blood count
  • Electrolyte levels
  • Blood clotting function
• Imaging tests of the liver such as:
  • Ultrasound scan
  • CT scan
  • MRI scan
• Endoscopy, in which a thin flexible tube with a lighted camera is passed through the esophagus to look for varices.
• Liver biopsy to determine the extent of damage to the liver, which is usually done only if diagnosis is inconclusive with other tests.

Treatment for alcoholic hepatitis may include the following:

Lifestyle changes

Ideally, the first and most important step in treating alcoholic hepatitis is immediate and complete alcohol abstinence, or at the very least, reducing intake considerably. To stop drinking, the patient may require:

• Medications to prevent the urge to drink and manage withdrawal symptoms
• Counseling
• Family support
• Joining support groups to reduce risk of relapse

Other lifestyle changes include:

• Giving up smoking (if the patient smokes)
• Taking in adequate nutrition, vitamins, and dietary supplements
• Following a healthy lifestyle and maintaining a healthy weight

Medical treatment

Medical treatment will depend on symptoms and complications. Liver inflammation is usually treated with corticosteroids, and antibiotics are prescribed if there is a bacterial infection. Complications from alcoholic hepatitis are likely to require invasive procedures or surgeries.

In cases of extreme liver damage and liver failure, a liver transplant may be an option, but liver is not an easily available organ, nor is every liver failure patient a suitable candidate. The patient’s health condition may not allow the immunity suppression that is required to prevent transplant rejection.

Prognosis for alcoholic hepatitis depends on the extent of liver damage and whether the person abstains from alcohol or continues drinking. The chances of full recovery from mild alcoholic hepatitis are excellent with total and immediate alcohol abstinence. Severe alcoholic hepatitis with complications has significantly high mortality, particularly if a person continues drinking.

In mild and moderate disease with no complications, 30-day mortality may be less than 20%. However, mortality can exceed 40% in the case of severe alcoholic hepatitis with extensive liver damage and complications (decompensated liver disease). Overall, the 1-year mortality rate after hospitalization for alcoholic hepatitis is approximately 40%.