Alcoholic hepatitis

What is alcoholic hepatitis?

It is liver damage caused by alcohol consumption, usually over a prolonged period.

Causes

The amount and duration of alcohol intake determines the likelihood and severity of liver damage. Additionally, women, individuals with a genetic predisposition to alcohol, people with other liver diseases, and those who are malnourished are at greater risk of developing liver disease.

It is worth noting that, beyond causing liver disease, alcohol contributes to various other conditions, such as diseases of the pancreas and heart, and increases the risk of digestive tract cancers and brain atrophy. Alcohol abuse is also strongly linked to traffic accidents and domestic violence.

Incidence

Worldwide, about 10 to 12% of people abuse alcohol. This abuse affects men twice as often as women. Although precise statistics are not available for Brazil, the problem is likely of similar or greater magnitude, with some studies showing alcohol abuse in up to 13% of the Brazilian population.

Symptoms

Most of the alcohol ingested, after being absorbed by the digestive tract, is processed (metabolized) by the liver. As alcohol is processed, substances that can damage the liver are produced. Alcohol abuse can cause three types of liver damage:

• fat accumulation (fatty liver or hepatic steatosis): the initial and most common consequence of excessive alcohol consumption. It is potentially reversible and occurs in over 90% of heavy drinkers
• inflammation (alcoholic hepatitis): the liver becomes inflamed in about 10% to 35% of people who consume large amounts of alcohol in a short period
• cirrhosis: about 10% to 20% of people develop cirrhosis (liver fibrosis or scarring with impaired function) when alcohol is consumed abusively over a long period

Alcohol concentration in beverages is often described in degrees, which are roughly twice the alcohol percentage. Different types of drinks contain different alcohol percentages:

• beers: between 2% and 7%
• wines: between 10% and 15%
• distilled spirits: between 40% and 45%

Alcohol intake above 40g/day for men and 20g/day for women is considered potentially harmful.

Fatty liver usually does not cause symptoms.

Acute alcoholic hepatitis may present with general malaise, nausea, vomiting, jaundice (yellowing of the skin and mucous membranes), dark urine (choluria), and pale stools (acholia). This condition can become severe, requiring specific treatment, with increased risk of infections and even death.

As alcoholic liver disease progresses to cirrhosis, several other symptoms may appear, some quite characteristic, such as malnutrition, ascites (fluid accumulation in the abdomen), vomiting blood, anemia, gynecomastia (enlarged breast tissue), and episodes of mental confusion. Liver cancer occurs in 10% to 15% of people with established cirrhosis.

Diagnosis

Diagnosis is based on chronic alcohol intake, a detailed physical examination, blood tests to assess liver function, and the exclusion of other liver diseases, along with imaging tests such as ultrasound, CT scan, or MRI of the abdomen. Alcohol is always suspected as a cause of liver disease in any patient with excessive and chronic alcohol consumption. A liver biopsy (removal of a tissue sample for analysis) is often required to confirm cirrhosis and determine its cause. Evaluation can also be done non-invasively through liver elastography, for example.

Treatment

Abstinence is generally the best treatment. Various strategies can help motivate the patient to change behavior, such as behavioral therapy, psychotherapy, support and self-help groups (like Alcoholics Anonymous), and counseling sessions. Some medications help reduce withdrawal symptoms and the craving for alcohol. A nutritious diet and vitamin supplements (especially B vitamins) are important during the first days of abstinence. They help correct nutritional deficiencies that cause complications such as weakness, tremors, difficulty walking, and anemia.

Severe cases of acute alcoholic hepatitis and cirrhosis often require hospitalization, corticosteroid use, and, in extreme cases, liver transplantation—provided the patient has stopped drinking alcohol.

By Einstein Editorial Board