As we say goodbye to another summer and begin to plan for the change in seasons and upcoming sports seasons, we also begin to think of alcohol use and how it affects us. With the advancements in the treatment of hepatitis C has come a decline in the number of patients with hepatitis C needing a liver transplantation. Cirrhosis from alcohol use has replaced hepatitis C as the leading indication for liver transplantation in America. The million-dollar question is “Who gets liver disease from alcohol use?” Millions of Americans drink alcoholic beverages yet very few will ever develop liver issues.
Alcohol causes a spectrum of liver disease from fatty liver to acute hepatitis to cirrhosis and its complications. As little as two glasses of wine a day can cause significant liver disease, especially in women. Women in general more prone to alcohol related liver disease than men are. Alcoholic fatty liver is the most common condition caused by alcohol. This condition is usually benign and can be reversed simply by stopping drinking. People who develop abnormal liver tests following alcohol intake that normalize in the absence of drinking should take heed that they are at increased risk for the development of more significant scarring and cirrhosis with continued alcohol use. Those people had a warning shot that they responded to and they should never drink any alcohol again.
Alcoholic hepatitis is caused by binge drinking on top of chronic liver disease. People with alcoholic hepatitis seek medical attention with a multitude of complaints such as nausea, pain over the right upper area of the abdomen, low-grade fever, and jaundice. On examination, the liver is enlarged and tender to palpation. When blood testing is done, the liver tests are elevated and the bilirubin is high. In a many people with this condition, survival is less than fifty-fifty and patients progress to liver failure, bleeding and death. Mostly, these patients are not candidates for liver transplantation although some transplant centers will transplant select candidates even if they were drinking up until the day they are admitted to a hospital. Alcoholic hepatitis occurs in about twenty percent of percent of heavy drinkers and only occurs in people with significant underlying liver scarring. T
herefore, having alcoholic hepatitis means that the person has significant liver disease and is in trouble. The treatment is a combination of nutrition and steroids for severe cases, in the short term. The only way to prevent recurrence is to stop all alcohol intake.
Cirrhosis caused by alcohol looks no different than most other causes of cirrhosis, although the risk of developing liver cancer may be higher. Most people with alcoholic cirrhosis are malnourished and will progress to some type of complication ranging from weight loss, jaundice, liver failure, esophageal variceal bleeding, ascites, confusion and liver cancer. The treatment of alcoholic cirrhosis is cessation of alcohol intake and management of complications. Eventually, liver transplantation can be used to treat end stage disease.
So what is the take home message regarding alcohol and the liver. In the vast majority of people, responsible alcohol use will not lead to liver disease. Advanced liver disease from alcohol may occur with greater frequency in smaller individuals, especially women and young adults. Alcohol use should be avoided in patients with underlying liver disease, especially those with chronic hepatitis C.
Overall, the use of alcohol requires good common sense. Everything in moderation, nothing in excess, remains a good axiom to live by. If there are any concerns about alcohol use, these concerns should be addressed to your physician.