What is alcoholic liver disease?
Alcoholic liver disease – otherwise known as alcohol-related liver disease (ARLD) – is liver damage caused by drinking too much alcohol (alcohol misuse).
It happens because drinking too much alcohol over many years damages liver cells and can also stop your liver from forming new cells (regenerating) when it needs to. This can lead to permanent liver damage.
In general, you’re more likely to develop alcoholic liver disease and it’s more likely to be worse, the more alcohol you drink, the longer you’ve drunk it for and the more often you drink it. But remember that this is a general trend – some people may get more liver damage from drinking less alcohol, less often and for a shorter amount of time than others.
Alcohol misuse can cause 3 types of liver disease, which appear in the following stages:
Stage 1: Alcoholic fatty liver disease
In this first and least serious stage, fat builds up in your liver, but it usually doesn’t cause any symptoms. Alcoholic fatty liver can usually be reversed if you stop drinking more than the recommended amount of alcohol.
Stage 2: Alcoholic hepatitis
If you continue drinking a lot of alcohol, your liver can become inflamed – this is known as hepatitis. At an early stage, the inflammation is mild and may not cause any symptoms. It may also be reversed if you stop drinking at this stage. But if you carry on drinking and the inflammation progresses, it can cause serious liver damage and symptoms.
Stage 3: Cirrhosis
The final stage of alcohol-related liver disease is cirrhosis. This is when a lot of your normal liver tissue is permanently replaced with a tough scar tissue – known as liver fibrosis – that stops your liver from working properly.Your liver may shrink over time, leading to end-stage liver failure, where your liver stops working completely. Cirrhosis of the liver can’t be reversed, but if you stop drinking before it turns into end-stage liver failure, you may help avoid more damage to your liver.
Alcoholic liver disease symptoms
The symptoms of alcohol-related liver disease can vary according to the stage. If you have stage 1 alcoholic liver disease – that’s alcoholic fatty liver disease – you may have no symptoms at all.
And early on in stage 2 – mild alcoholic hepatitis – you may also have no symptoms and only discover you have it if blood tests show you have high levels of a substance, called liver enzymes, made by the liver in your blood.
But for some people, it’s possible to have some early symptoms of alcoholic liver disease, including:
- tummy pain
- feeling tired and generally unwell
- feeling sick (nausea)
- loss of appetite
As the condition progresses into the later stages, symptoms tend to become more common and can include those mentioned above and:
- tummy swelling (ascites)
- swelling of your legs, ankles and feet (oedema)
- yellowing of your skin and the whites of your eyes (jaundice)
- itchy skin
- dark coloured pee
- light coloured and/or foul-smelling poo
- being sick (vomiting)
- losing a lot of weight without meaning to
- muscle weakness and wasting
When to see a doctor about alcoholic liver disease
You should see a doctor as soon as possible if you have any of the symptoms listed above, or if you don’t have symptoms but think you may have liver damage from drinking alcohol.
In serious cases, liver disease can cause complications that are a medical emergency. Call an ambulance or go to the emergency department if:
- you feel confused or drowsy
- you’re vomiting blood or something that looks like coffee grounds
- your poo looks bloody or dark and like tar
- you’re bleeding from any part of your body and you can’t stop the bleeding
You should also see a doctor as soon as possible if you think you’re drinking too much or you’re having trouble cutting down on how much you drink. They can help you find ways to safely cut down.
If you drink a lot of alcohol, it’s important to not cut down suddenly without speaking to a doctor because this can cause serious side effects that can be life-threatening in some cases.
What causes alcoholic liver disease?
Alcoholic liver disease is caused by drinking too much alcohol for a long time, usually years. In some cases, you can get liver damage from binge drinking, which is drinking a lot of alcohol in a short amount of time. But this usually causes stage 1 alcoholic liver disease – alcoholic fatty liver disease – rather than the later stages of alcohol-related liver disease.
Drinking more than the recommended limits of alcohol over many years means you’re more likely to get alcoholic liver disease and the more serious types, or later stages of this disease – hepatitis and cirrhosis.
So, it’s important to know what the recommended limits are. Recommendations vary between different countries, but in the UK, all adults are advised to drink no more than 14 units of alcohol per week. And these 14 units should be spread out over at least 3 days.
How is alcoholic liver disease diagnosed?
Because alcoholic liver disease doesn't tend to cause symptoms early on, you may only discover you have it while having tests for something else.
But if you have symptoms, a doctor may suspect alcohol-related liver disease based on these symptoms, a physical exam and your drinking habits.
You may also need some tests, including:
- blood tests to check your liver function (liver function tests [LFTs]) – these tests check your liver function by looking at the levels of specific substances your liver makes. If these levels fall outside the normal limits, they can suggest liver disease
- blood tests to check for other substances your liver normally makes, including those that help your blood clot
- imaging scans, like an MRI, CT or ultrasound scan, to take a closer look at your liver
- a liver biopsy to confirm the cause of any liver damage, the type of damage and how bad the damage is
A doctor may also want to check if your drinking habits could be a problem, which may include giving you a questionnaire to complete.
What can you expect after having alcoholic liver disease?
What to expect with alcoholic liver disease depends on the stage you’re at. If you have alcoholic fatty liver or early-stage alcoholic hepatitis, stopping drinking alcohol can help reverse the damage. But if you have later stage alcoholic hepatitis or cirrhosis, this is more serious. Not drinking alcohol can help to prevent more damage, but you may have ongoing symptoms or complications and need medical support.
Your outcome is likely to be better if alcohol-related liver disease is caught and treated at an early stage, so see a doctor if you think you have it or you’re worried about the effect of your drinking habits on your body.
What is the treatment for alcoholic liver disease?
If you have alcohol-related liver disease, the best thing you can do is stop drinking alcohol, with advice from a doctor – it’s the only treatment (aside from having a liver transplant) that can reverse or slow down the liver damage.
If you’re at an early stage, you may not need to stop drinking forever. It’s thought that not drinking for 2 weeks is enough to reverse alcoholic fatty liver disease (stage 1 of alcoholic liver disease) and after that time, it may be OK to drink if you stick to the recommended limits.
But once you’ve got to stage 2 (alcoholic hepatitis), you’ll need to stop drinking forever to help keep the damage from getting worse.
Not drinking can be hard, so it’s important to have the right support system when you do so. Start by speaking with a doctor before making any changes. They’ll help you make a plan to cut down safely. Don’t try to stop suddenly on your own because this can be dangerous.
You may also find local support groups helpful when giving up alcohol. Speak to a doctor for advice on how to find and join these groups. Read more about getting help and support for alcohol misuse.
Aside from not drinking alcohol, you may also need treatment for the symptoms and complications caused by any liver damage you have. This treatment may involve:
- eating a balanced diet and taking supplements – it’s common to be low in key nutrients when you have alcoholic liver disease. Eating a healthy, balanced diet can help you get the vitamins and minerals your body needs to function well. A doctor may also recommend extra supplements, like B vitamins. Speak to a doctor or nutritionist for advice on a diet that works for your needs
- medications to ease alcohol withdrawal symptoms – when you stop drinking alcohol, you may develop some symptoms during the first few days. These usually improve after a week, but medications, like sedatives, can help to ease these symptoms if they’re serious. Read more about managing alcohol withdrawal
Sometimes, medications that reduce inflammation are used to help improve existing liver damage. But it’s not clear how effective these treatments are.
When alcoholic liver disease reaches its most serious stage and your liver can’t function at all anymore, a doctor (usually a liver specialist called a hepatologist) may recommend a liver transplant. This specialist will usually be able to tell you all you need to know about the operation and help guide you through the process of making the decision to have (or not have) a transplant.
Read more about what a liver transplant involves.
Your health questions answered
What are signs your liver is healing?
It’s not always easy to tell if your liver is healing because alcoholic liver disease doesn’t usually cause symptoms in its early stages. But blood tests, called liver function tests, that measure how well your liver is working can be useful in showing you if your liver is healing. Imaging tests, like an ultrasound or CT scan, may also show when signs of liver disease, like alcoholic fatty liver, are improving.
How long does it take your liver to recover from a night of drinking?
A night of heavy drinking is also known as binge drinking and this can cause early-stage liver damage, known as alcoholic fatty liver. But not drinking for 2 weeks can help to reverse this damage. But, this doesn’t mean it’s safe to binge drink every 2 weeks. If you binge drink regularly over many years, you’re more likely to develop later-stage liver damage that can’t be reversed.
How long do you need to abstain from alcohol for the liver to repair itself?
Too much alcohol can damage the liver, but if you stop drinking alcohol, this allows your liver cells to regenerate and heal the liver. However, drinking too much alcohol over many years interferes with the liver's ability to heal itself, which may lead to permanent damage. If you’re concerned about the amount of alcohol you drink, speak to a doctor so that they can check your liver’s health and advise you. – Answered by Dr Shailen Sutaria from the Healthily Medical Team
- alcoholic liver disease, or alcohol-related liver disease, is liver damage caused by drinking too much alcohol
- it happens in 3 stages: alcoholic fatty liver, alcoholic hepatitis and cirrhosis
- not drinking alcohol is the best treatment for alcoholic liver disease
- see a doctor if you think you drink more than the recommended limit, but don’t try to cut down on your own as this can be dangerous
- when alcoholic liver disease reaches its most serious stage and your liver isn’t working properly anymore, a doctor may recommend a liver transplant