Alcoholic liver disease refers to a range of conditions and associated symptoms that develop when the liver becomes damaged due to alcohol misuse.
Alcoholic liver disease does not usually cause any symptoms until the liver has been extensively damaged. When this happens, alcoholic liver disease can cause:
- weight loss
- loss of appetite
- jaundice (yellowing of the eyes and skin)
With the exception of the brain, the liver is the most complex organ in the body. It has more than 500 functions, most of which are essential for living.
The functions of the liver include:
- filtering toxins from the blood
- producing important chemicals, such as proteins and hormones
- producing blood-clotting agents that prevent excessive bleeding
- regulating cholesterol levels in the blood
- helping to fight infection and disease
- storing energy for use when the body needs an immediate energy boost
Alcohol and the liver
The liver is a very tough and resilient organ. It can endure a high level of damage that would destroy other organs. It is also capable of regenerating itself. Despite this resilience, prolonged alcohol misuse over many years can damage the liver.
Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood.
Each time your liver filters alcohol, some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose its ability to regenerate new cells, causing serious damage.
Stages in alcoholic liver disease
There are three main stages of alcoholic liver disease, though there is often a considerable overlap between each stage. These stages are explained below.
Alcoholic fatty liver disease
Alcoholic fatty liver disease is the first stage of alcoholic liver disease.
Heavy consumption of alcohol, even for only a few days, can lead to a build-up of fatty acids in the liver.
Fatty liver disease rarely causes any symptoms but it is an important warning sign that you are drinking at a level that is harmful to your health.
Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.
Alcoholic hepatitis is the second more serious stage of alcoholic liver disease.
Prolonged alcohol misuse over many years can cause the tissues of the liver to become inflamed. This is known as alcoholic hepatitis. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).
Alcoholic hepatitis is usually reversible, though you may need to stop drinking alcohol for several months or years.
Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis occurs when prolonged inflammation of the liver has caused scarring of the liver and subsequent loss of function. Loss of liver function can result in death.
The damage caused by cirrhosis is not reversible. In mild to moderate cases, stopping drinking alcohol immediately should prevent further damage and lead to the gradual recovery of liver function. In more severe cases, a liver transplant may be required.
How common is alcoholic liver disease?
Alcoholic liver disease is widespread in Ireland.
It is estimated that:
- 90-100% of heavy drinkers have alcoholic fatty liver disease
- one in four drinkers with fatty liver disease will develop alcoholic hepatitis
- one in five drinkers with fatty liver disease will develop cirrhosis
A heavy drinker is someone who regularly exceeds the recommended weekly limit for alcohol consumption. This is 21 standard drinks per week for men and 14 for women.
Women are more likely to develop alcoholic liver disease, but men are more likely to die from it, possibly because men tend to be heavier drinkers.
In the period 2004-2008 the Health Research Board estimates that there were 700 deaths in Ireland due to alcoholic liver disease. Acohol is one of the most common causes of death, along with smoking and high blood pressure.
Fatty liver disease and hepatitis can develop at any age. Cirrhosis usually develops in people aged 40 or over. However, cases of cirrhosis have been reported in people of all ages, including teenagers.
The outlook for alcoholic liver disease largely depends on whether you are willing to stop drinking alcohol, preferably for the rest of your life.
In the early stage of alcoholic liver disease (fatty liver and hepatitis), people who stop drinking have a very good outlook as their liver has the opportunity to repair itself.
Even in cases of cirrhosis, the outlook can be improved dramatically by stopping drinking, not least because you will only be considered for a liver transplant if you do not drink alcohol for at least three months.
Three out of four people with cirrhosis who have a liver transplant will live for at least five years after receiving the transplant, and many will live much longer.