Causes, symptoms and treatment of alcoholic liver disease

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Alcoholic liver disease results from over consumption of alcohol, damaging the liver and leading to a buildup of fats, inflammation, and scarring.

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The liver is one of the most complex organs in the human body, with over 500 functions. These include:
Filtering blood toxins
Storing energy
Making hormones and proteins
Regulating cholesterol and blood sugar
In 2015, 16.5% of all liver transplants in the United States occurred due to alcoholic liver disease, making it the third most common reason for transplants behind chronic hepatitis C and liver cancer.
According to th e Centers for Disease Control and Prevention (CDCP), in 2020, the number of deaths from alcoholic liver disease in the U.S. was 29,505.
Alcoholic liver disease has four main stages:
Alcoholic fatty liver disease
Alcoholic hepatitis
Fibrosis
Cirrhosis
Liver damage can affect the whole body. Once damage begins, it can take a long time to become noticeable, as the liver is generally highly effective at regenerating and repairing itself. Often, by the time doctors detect the damage, it is irreversible.

Signs and symptoms
The early signs of alcoholic liver disease are vague and affect a range of systems in the body.
Along with a general feeling of being unwell, signs can include:
Pain in the abdomen
Nausea and vomiting
Diarrhea
Decreased appetite
It can be easy for someone to dismiss the early symptoms as the effects of a stomach bug or general malaise. However, leaving these symptoms undiagnosed and untreated — especially while continuing to consume alcohol — can lead to a faster progression of liver disease over time.

Alcoholic fatty liver disease
Drinking a large volume of alcohol can cause fatty acids to collect in the liver. Sometimes, heavy drinking over a short period, even less than a week, can cause this.
There are normally no symptoms, and alcoholic fatty liver disease is often reversible if the individual abstains from alcohol from this point onward.

Alcoholic hepatitis
Alcoholic hepatitis is a severe syndrome of alcoholic liver disease. Hepatitis is a general term for swelling and inflammation of the liver from any cause.
If a person continues to drink alcohol it will lead to ongoing liver inflammation. This can occur after many years of heavy drinking. It can also occur acutely during periods of binge drinking.
Common symptoms of alcoholic hepatitis are:
Jaundice, or a yellow tint of the whites of the eyes and the skin
Enlarged liver, known as hepatomegaly
Features of systemic inflammatory response, including any of the two below:
Body temperature under 96.8°F (36°C) or over 100.4°F (38°C)
Heart rate higher than 90 beats per minute
Respiratory rate greater than 20 breaths per minute
White blood cell count above 12000 or less than 4000 per microliters
Alcoholic hepatitis usually progresses to cirrhosis if a person continues to drink alcohol. Hepatitis heals in a person who stops drinking alcohol, but any cirrhosis does not reverse.

Fibrosis
Fibrosis is a buildup of certain types of protein in the liver, including collagen. It features in most types of chronic liver disease.
To determine the extent of fibrosis, doctors use the Metavir scoring system on a scale from A0–A3:
A0: no activity
A1: mild activity
A2: moderate activity
A3: severe activity
Mild-to-moderate forms of fibrosis may be reversible.
The Metavir system also rates the level of fibrosis from F0–F3:
F0: absence of fibrosis
F1: fibrosis with no scar tissue
F2: fibrosis with occasional scar tissue
F3: extensive scarring but no cirrhosis
F4: cirrhosis

Cirrhosis
Cirrhosis occurs when the liver has been inflamed for a long time, leading to scarring and loss of function. This can be a life threatening condition. Cirrhosis damage is irreversible, but a person can prevent further damage by continuing to avoid alcohol.
Lifelong abstinence can improve liver function, but the permanent and severe damage from cirrhosis might mean that the person needs a liver transplant to survive.
As the liver no longer processes toxins properly, a person will be more sensitive to medications and alcohol. Alcohol use speeds up the liver’s destruction, reducing the liver’s ability to compensate for the current damage.

Late-stage signs
Once the alcoholic liver disease progresses, its symptoms become easier to recognize.
The more distinctive signs of late-stage liver disease, such as cirrhosis or fibrosis, include the following:
Adema, or swelling of the lower limbs
A buildup of fluid in the abdomen — ascites
Fever and shivering
Extremely itchy skin
Fingernails that curve excessively — clubbing
Losing a significant amount of weight
General weakness and wasting muscles
Blood in vomit and stools
Bleeding and bruising more easily
More sensitive reactions to alcohol and drugs

“Once a doctor diagnoses a person with alcoholic liver disease at any stage, they will recommend them to never resume drinking. Any conditions that have reversed will typically return once drinking restarts”

Risk factors
Several factors increase the risk of alcoholic liver disease.
People who drink beer and liquor may be more likely to experience liver disease when compared with those who consume other alcoholic beverages, such as wine.
Females are more susceptible to the negative effects of alcohol, even at the same levels of alcohol intake as males, so are more likely to quickly develop fibrosis, inflammation, and liver injury as a result of alcohol.
According to the American College of Gastroenterology, females who consume more than two drinks per day and males who consume more than three drinks per day for more than 5 years are at an increased risk for alcoholic liver disease.
Females who consume high amounts of alcohol and also carry excess body weight have a greater chance of developing chronic liver disease. However, obesity is also a risk factor for males.
Having hepatitis C increases the risk, and a person who consumes alcohol regularly and has had any type of hepatitis faces a higher chance of developing liver disease.
Genetic changes can affect the risk. If a person experiences changes in the genetic profiles of particular enzymes that are key to alcohol metabolisms, such as ADH, ALDH, and CYP4502E1, they will have a higher chance of developing alcoholic liver disease.

Treatment
The first step in treating any level of the alcoholic liver disease focuses on removing alcohol from the diet.

Abstinence
This can help to reverse some early stages of liver disease. For example, stopping drinking once diagnosed with fatty liver disease may be able to reverse the condition within 2–6 weeks .
Once a doctor diagnoses a person with alcoholic liver disease at any stage, they will recommend them to never resume drinking. Any conditions that have reversed will typically return once drinking restarts.
Those who regularly drink more than the recommended daily limits of alcohol should not stop drinking without medical support. Withdrawal from alcohol can be life-threatening. Individuals should seek help from a medical professional to safely manage alcohol withdrawal.

Therapy
Cognitive behavioral therapy (CBT) and medications called benzodiazepines can ease withdrawal symptoms in a person with alcohol dependency. People with severe alcohol dependency may stay at an inpatient rehabilitation facility for closer monitoring.
Ongoing therapy may then be required to prevent a relapse into drinking alcohol. Medications can also prevent relapse, such as:
Acamprosate
Vivitrol (naltrexone)
Topamax (topiramate)
baclofen
disulfiram
Lifestyle changes
Doctors may also recommend weight loss and quitting smoking as excess weight and smoking have both demonstrated a role in worsening alcoholic liver disease. Doctors may also recommend taking a daily multivitamin.

Medications
Corticosteroids or pentoxifylline may help reduce inflammation in people with acute alcoholic hepatitis while receiving hospital treatment.
Other medications that show potential for treatment and are currently being studied include:
Probiotics and antibiotics
Stem cell therapy
Medicines that target the inflammation pathway

Liver transplant
In people with liver failure, the liver completely ceases to function. This can be an outcome of advanced-stage liver disease and often means that a liver transplant is the only option for prolonged survival. A liver transplant is a complicated procedure that depends on a donor’s availability.
Typically, only people who can show at least 6 months of abstinence from alcohol before the procedure will be suitable candidates for a transplant. A liver transplant is a last resort. Quitting alcohol and treating this condition early on is the best way for a person to increase their chances of reversing or slowing the disease.

Prevention
To prevent alcoholic liver disease and other conditions linked to the consumption of alcohol, doctors advise people to follow National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines.
The guidelines classify moderate drinking up to one drink a day for females, and up to two drinks for males, and only over the age of 21 years.
One drink is equivalent to:
12 fluid ounces (oz) of beer at 5% alcohol
5 oz of wine at 12% alcohol
1.5 oz of spirits at 40% alcohol
The NIAAA defines binge drinking as five or more alcoholic drinks for males or four or more alcoholic drinks for females on the same occasion, on at least 1 day in the past month.

Outlook
The life expectancy of a person with alcoholic liver disease reduces dramatically as the condition progresses.
On average, 1 in 3 people with the most advanced stage of liver disease and cirrhosis are still alive after 2 years. When the body can compensate and manage cirrhosis, the typical lifespan is 6–12 years. Those with less severe diseases will survive longer if they abstain from alcohol.
Not smoking and controlling body weight are significant lifestyle changes people can make to further reduce the risk.

Source@medicalnewstoday.com