Alcoholic Liver Disease: Reversibility, Signs, Stages

Alcoholic liver disease (ALD) is caused by excessive alcohol consumption, which is defined as five or more drinks in a day or 15 or more drinks a week for men, and four or more drinks a day or eight or more drinks a week for women.

The liver is responsible for metabolizing or processing ethanol, the main component of alcohol. Over time, the liver of a person who drinks heavily can become damaged and cause alcoholic liver disease.

Early damage to the liver causes fat to deposit onto the liver, resulting in hepatic steatosis, or alcoholic fatty liver disease. Fatty liver disease often has no symptoms and can usually be reversed.

If the alcoholic liver disease is not treated, it can progress to later stages which include alcoholic hepatitis and cirrhosis, a scarring of the liver.

This article will discuss the stages of alcoholic liver disease, the possibilities of reversing the disease, typical symptoms, complications, diagnosis, treatment options, and how best to support the liver during treatment.

Alcoholic Liver Disease Stages: Reversibility and Healing

Alcoholic liver disease ranges in severity. There are three stages of liver disease.

Alcoholic fatty liver disease appears early on as fat deposits accumulate in the liver. Often there are no symptoms. People who consume four to five standard drinks per day over decades can develop fatty liver disease.

Fatty liver disease can also develop after binge drinking, which is defined as drinking four to five drinks in two hours or less. About 90% of heavy drinkers will develop alcoholic fatty liver disease.

Alcoholic hepatitis occurs when the liver becomes damaged and inflamed. Symptoms include fever, jaundice (yellowing of the skin), malnourishment, swelling, and accumulation of fluid around the liver.

Although 90% of people who drink heavily develop fatty liver disease, only 20% to 40% will go on to develop alcoholic hepatitis.

Alcoholic cirrhosis is a progression of ALD in which scarring in the liver makes it difficult for that organ to function properly. Symptoms include weight loss, fatigue, muscle cramps, easy bruising, and jaundice.

Cirrhosis can lead to liver failure. In liver failure, the liver is severely damaged and can no longer function. Other organs, such as the kidneys, and body systems such as the respiratory system, may also begin to fail.

The prognosis for liver failure is poor and requires immediate treatment, often in the intensive care unit.

Though rare, liver cancer can develop from the damage that occurs with cirrhosis.

What Is Possible?

Fatty liver disease can often be reversed by stopping drinking alcohol. After two to three weeks of abstaining from alcohol, fatty deposits disappear and liver biopsies appear normal.

However, if the person drinks alcohol again heavily, the fatty deposits will reappear.

What Stages Aren’t Reversible?

Although stopping drinking alcohol is the most effective treatment for alcoholic liver disease, it is not a complete cure. People who have progressed to alcoholic hepatitis or cirrhosis most likely will not be able to reverse the disease.

In these cases, treatment focuses on preventing further damage and treating other factors that can make the disease worse, such as infection and malnourishment.

Permanent Damage From Alcoholic Liver Disease

The liver can usually repair itself and generate new cells. However, in advanced alcoholic liver disease, liver regeneration is impaired, resulting in permanent damage to the liver. This can result in liver failure.

Liver Failure Stages 

Cirrhosis is considered end stage liver disease as it cannot be reversed and can lead to liver failure. Cirrhosis is further categorized as compensated and decompensated.

In compensated cirrhosis, the liver remains functioning, and many people have no symptoms. The median life expectancy from this point is 10 to 12 years.

In decompensated cirrhosis, symptoms become more apparent. Someone with decompensated cirrhosis may develop ascites (or fluid in the abdomen), gastrointestinal bleeding, and hepatic encephalopathy, in which the brain is affected. The median life expectancy drops to one to two years.

When Does Alcoholic Liver Disease Cause Symptoms?

Alcoholic liver disease often begins without any symptoms.  

Early Symptoms

Most people will not experience symptoms in the early stages of ALD. Some may experience mild pain in the upper right side of the abdomen.

Progressive Symptoms

Symptoms of ALD that has progressed include:

• Jaundice
• Malnutrition
• Fever
• Fatigue
• Swelling
• Brain function decline, known as hepatic encephalopathy, which can cause memory loss, confusion, slurred speech
• Reduced muscle mass
• Heart failure
• Peripheral neuropathy, damage to the nerves outside the central nervous system (the brain and spinal cord), usually in the hands and feet

Untreated Alcoholic Liver Disease Complications 

Left untreated, ALD can lead to other complications. ALD that has progressed can affect other parts of the body.

People with advanced ALD may experience complications such as:

• Bleeding in the intestinal tract
• Inflammation of the pancreas
• Kidney distress
• Acute respiratory distress syndrome, in which fluid collects in the lungs and deprives the body of oxygen
• Infection

Confirming Alcoholic Liver Disease Through Diagnosis

To diagnose ALD, a healthcare provider will assess alcohol use, ask about symptoms, and conduct several tests. An assessment of alcohol use will establish when alcohol consumption started, how much a person drinks, and how often.

At times, it may become necessary for a healthcare provider to talk with friends and relatives of the person with suspected ALD to establish the amount of alcohol consumed, as it may be difficult for the person to self-assess.

The signs and symptoms of ALD include but aren’t limited to:

• Nausea/vomiting
• Fatigue
• Weakness
• Lack of appetite, loss of interest in food
• Swollen or distended abdomen
• Fluid buildup or swelling in the feet and ankles

Tests that may be conducted look at liver function. These include blood tests that measure liver enzymes, imaging tests such as ultrasound of the liver, a specialized test called Fibroscan, which looks for fibrosis (scarring) in the liver, and, in some cases, a biopsy of the liver (removing a sample of tissue for analysis in a lab).

Initial Treatment for Early Alcoholic Liver Disease

Abstaining from drinking alcohol is the first step in treating ALD. A team of healthcare providers, which may include psychologists or addiction specialists, can help if you find it challenging to stop drinking.

Treatment also consists of evaluation for other risk factors that can damage the liver or put the liver at higher risk, such as infection with hepatitis C and metabolic syndrome.

Having hepatitis C or other liver diseases with heavy alcohol use can rapidly increase the development of cirrhosis. These diseases will also be treated.

Having a high body mass index (BMI, a calculation based on height and weight but not taking into account other variables affecting weight) has been shown to increase mortality rates (being subject to death) and the risk of liver cancer. Reducing weight if you’re overweight, eating a healthy diet, and regular exercise can help someone with early ALD who has stopped drinking decrease their risk of advanced liver disease.

Treatment for End-Stage Alcoholic Liver Disease 

After stopping drinking, which is the first step in any treatment of ALD, an assessment will be made as to the extent of the damage and the overall state of the body.

Many people with ALD are malnourished (lacking proper nutrition) due to a variety of factors, such as lack of eating, vomiting, and malabsorption (difficulty absorbing nutrients from food). In general, the more severe the ALD, the more malnourished someone becomes.

Getting adequate proteins, calories, and nutrients can alleviate symptoms, improve quality of life, and decrease mortality.

Corticosteroids are used to treat severe alcoholic hepatitis by decreasing inflammation in the liver. Other medications, such as Pentoxil (pentoxifylline), may also be used.

A liver transplant may become necessary in end-stage ALD. However, eligibility may depend on being abstinent from alcohol for a specific length of time.

Liver Health During Treatment

While treating ALD it is important not only to abstain from alcohol but also become conscious of other factors that could affect the liver.

What to Avoid

While treating ALD it is best to avoid:

• Foods that are high in fat, salt, and sugar.
• Fried foods
• Raw or undercooked shellfish, such as clams and oysters
• Medications that can affect the liver

How to Support Liver Function

To support liver function:

• Eat a balanced diet that consists of fruits, veggies, whole grains, lean protein sources (may include some meats, fish, or beans), and dairy.
• Eat high-fiber foods.
• Drink a lot of water.

Your healthcare provider may also test you for individual nutrient deficiencies. Many people with alcoholic liver disease are deficient in B vitamins, zinc and vitamin D and it may become necessary to take supplements.

Summary

Alcoholic liver disease is caused by excessive consumption of alcohol. There are three stages—alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis.

While the early stages may have no symptoms, later stages can cause symptoms such as fatigue, swelling in the hands and legs, jaundice, loss of appetite, and weakness.

Early treatment can reverse alcoholic fatty liver disease. However, if the disease progresses, it is often not reversible. The standard first-line treatment is to stop drinking. Medications and lifestyle modifications may also be prescribed depending on the stage.

Eating a healthy diet, getting regular exercise, and avoiding liver-damaging foods such as fried foods, can also help the liver heal during treatment. In some cases, supplementation with vitamins may be recommended.