Alcohol-related liver disease (ARLD) is caused by damage to the liver from years of excessive drinking. Years of alcohol abuse can cause the liver to become inflamed and swollen. This damage can also cause scarring known as cirrhosis. Cirrhosis is the final stage of liver disease.
ARLD is a major public health problem. About 8 to 10 percent of Americans drink heavily. Eventually, 10 to 15 percent will develop ARLD. Heavy drinking is classified as eight or more alcoholic beverages per week for women, and more than 15 for men.
Liver disease is just one of the consequences of excessive alcohol consumption. This is especially serious because liver failure can be fatal. Learn how you can prevent and treat this serious condition.
The symptoms of ARLD depend on the stage of the disease. There are three stages:
- Alcoholic fatty liver disease: This is the least severe of the stages of ARLD, where fat starts to accumulate around the liver. It can be cured by not drinking alcohol anymore.
- Acute alcoholic hepatitis: Alcohol abuse causes inflammation (swelling) of the liver in this stage. The outcome depends on the severity of damage. In some cases, treatment can reverse the damage, while more severe cases of alcoholic hepatitis can lead to liver failure.
- Alcoholic cirrhosis: This is the most severe form of ARLD. At this point, the liver is scarred (cirrhosis) from alcohol abuse, which cannot be undone. Cirrhosis can lead to liver failure.
Some people with ARLD don’t have symptoms until the disease is advanced. Others start showing signs earlier. Symptoms of ARLD include:
- loss of appetite
- abdominal discomfort
- increased thirst
- swelling in the legs and abdomen
- weight loss
- darkening or lightening of the skin
- red hands or feet
- dark bowel movements
- unusual agitation
- mood swings
- bleeding gums
- enlarged breasts (in men)
Symptoms of ARLD may show up more often after binge drinking.
Your risk of ARLD increases if:
- you have a family history of ARLD
- you often drink heavily
- you binge drink
- you have poor nutrition
Binge drinking may also cause acute alcoholic hepatitis. This can be life-threatening. Acute alcoholic hepatitis can develop after as few as four drinks for women and five drinks for men.
ARLD is not the only disease that can cause liver damage. Your doctor will want to test the health of your liver to rule out other diseases. Your doctor may order:
- complete blood count (CBC)
- liver biopsy
- liver function test
- abdominal computed tomography (CT) scan
- abdominal ultrasound
They may also order a liver enzyme test. Liver enzyme tests are often used to distinguish ARLD from other liver diseases. These tests determine the levels of three liver enzymes:
- aspartate aminotransferase (AST)
- alanine aminotransferase (ALT)
You’re likely to have ALD if your AST level is two times higher than your ALT level. According to the National Institute on Alcohol Abuse and Alcoholism, this finding is present in over 80 percent of ARLD patients.
ARLD treatment has two goals. The first is to help you stop drinking. This can prevent further liver damage and encourage healing. The second is to improve your liver health.
If you have ARLD, your doctor may recommend:
- alcoholic rehabilitation program: Programs such as Alcoholics Anonymous can help you stop drinking when you can’t stop on your own.
- multivitamins: B-complex vitamins are usually low in people who drink heavily. This deficiency can cause anemia or malnutrition.
- liver transplant: this may be necessary if your liver is too scarred by cirrhosis to function properly.
- vitamin A supplements: many people with ARLD are severely vitamin A-deficient.
It’s important to note that taking vitamin A and alcohol together can be deadly. Only people who have stopped drinking can take these supplements. Supplements will not cure liver disease, but they can prevent complications like malnutrition.
Complications of ARLD may include:
- permanent liver scarring and loss of function
- bleeding esophageal varices (enlarged veins in the esophagus that develop in people who have liver disease)
- high blood pressure in the blood vessels of the liver (portal hypertension)
- a loss of brain function caused by the build-up of toxins in the blood (hepatic encephalopathy)
ARLD can shorten your lifespan. However, stopping drinking can help. You can also recover from malnutrition by changing your diet and taking appropriate supplements (if needed). It’s not too late to change lifestyle habits if you or a loved one drinks excessively.
Talk to your doctor if you think you have a problem with drinking or are at risk for developing liver disease. They can refer you to programs to help you stop drinking and improve the health of your liver.