Drink enough alcohol, and you are going to damage your liver. This will happen quickly or over a longer period of time but you may not know until it’s too late. The number of deaths in the UK as a result of liver disease associated with alcohol is on the increase!
Up to one in three adults drinks enough alcohol to create a risk of developing alcohol-related liver disease.
There have been a number of studies looking into the relationship between alcohol consumption and liver disease. There are no clear outcomes related to the amount consumed and the trigger that causes the disease. Some studies have suggested drinking about 3.8 units an upwards, per day increased the risk of liver disease, however other studies suggest as little as 2.5 units per day doubled the risk but thereafter found the risk did not increase with each additional unit. You may conclude you are at as much risk drinking 2.5 units per day as someone drinking 18 units per day.
Other risk factors include:
- Gender: Women are more susceptible to alcohol-related liver damage than men, with one study suggesting the risk is almost 50% higher
- Body mass index: Being overweight or obese increases the risk of alcohol-related liver disease
- Race: Some data suggests people of African origin are more susceptible than Caucasians
- Pattern of drinking: Drinking alcohol only at meal times appears to carry a lower risk of alcohol-related liver disease than other patterns of alcohol consumption
There are two patterns of liver disease, acute (known as acute alcoholic hepatitis) and chronic, which reflect whether it develops over a matter of months or years respectively.
Chronic Liver Disease
There are four stages of chronic liver disease:
- The commonest and mildest form of liver damage is a ‘fatty’ liver. This can be identified by blood tests, and is reversible with abstinence from alcohol.
- The next step cannot be identified by blood tests, but a liver biopsy will show inflammation in addition to the excess fat. This is called steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis can then be made (see below).
- At the next stage, fibrosis (scar tissue) is present. Again, this cannot be detected by blood tests or routine scans.
- Cirrhosis occurs when the fibrosis reaches the stage when the normally soft liver is divided into thousands of pea-sized pockets of liver tissue, wrapped in fibrosis. Once cirrhosis develops, the prognosis partly depends on whether or not you continue drinking. People with compensated cirrhosis – meaning they have no symptoms – and who then stop drinking, have an 80% chance of being alive after 10 years.
The majority of those with decompensated cirrhosis – displaying symptoms – will die within three years.
Acute Liver Disease – known as Acute Alcoholic Hepatitis
This type of liver disease is caused by heavy drinking over a period of months. This is the pattern that is likely to occur when young people get liver disease, although older people who drink excessively later in life are also susceptible. It is potentially reversible with no long-term effects if you recover and stop drinking alcohol completely.
However, 70-90% of patients with acute alcoholic hepatitis – likely to be those who have been drinking for longer, and therefore unlikely to be young people – will have cirrhosis. Jaundice is the usual first symptom. In hospitalised cases, there’s a mortality rate of around 50% associated with acute alcoholic hepatitis. Liver transplants are usually not an option, partly because of the history of recent alcohol abuse.
The majority of patients who develop cirrhosis will have been unaware of the earlier stages of the disease, unless tests have been carried out. Early symptoms of liver disease can be non-specific, including fatigue, nausea, vomiting, diarrhoea or abdominal pains. For heavy drinkers, early monitoring could help detect liver damage before it reaches an advanced stage. Eventually, when liver damage does reach a more advanced stage, specific liver-related symptoms can develop because of:
- Liver failure: seen as jaundice, or encephalopathy – mental effects caused by the liver’s inability to clear toxins from the blood
- Portal hypertension: an increase in pressure in the vein draining blood in to the liver, which can lead to bleeding in the gut
- Cancer, with the development of the liver cancer known as hepatocellular carcinoma.
British Liver Trust – the national charity for adults with liver disease. The Trust campaigns to highlight the problem of liver disease in the UK. Visit their website or call the helpline (0800 652 7330).
For help in Scotland, you can contact Alcohol Focus Scotland, on 0141 572 6700.