Alcohol-related Liver Disease
What is ARLD?
Alcohol-related liver disease (ARLD) refers to a range of conditions where alcohol has caused damage to the liver. Alcohol causes damage to the liver both by damage to liver cells from breakdown products/metabolites of alcohol and by the accumulation of fat in liver cells. Over time, this damage leads to inflammation and scarring (fibrosis) in the liver, eventually leading to cirrhosis and its complications.
ARLD encompasses conditions which vary in severity ranging from alcohol-related fatty liver and alcoholic hepatitis which can occur with or without cirrhosis. ARLD is the most common cause for admission to hospital with liver disease and alcohol is associated with a high proportion of emergency department attendances in the UK.
How much alcohol is required to cause alcohol-related liver disease?
The amount of alcohol required to cause liver damage can vary hugely from person to person with factors including:
- Gender and body shape
- Genetic makeup
- Co-existing disease, e.g. obesity, diabetes, haemochromatosis
- Medications that can affect the liver
But the best way to minimise the chance of devloping ARLD is to keep within recommended guidelines for alcohol consumption.
How much alcohol is safe to drink?
For an adult who is otherwise well, the UK government recommends keeping to less than 14 units per week for men and women. There is no level of alcohol consumption that is completely without risk, but at this level, the risks are very small and so considered safe. Regular consumption above this level is considered hazardous (i.e. increases the risk of harm), while regularly drinking more that 50 units per week for a man or 35 units per week for a woman is considered harmful (i.e. likely to be causing harm).
Does the type of alcohol I drink affect the chances of developing liver disease?
No- people can develop liver disease from too much of any sort of alcoholic drink.
How do I interpret units of alcohol?
Alcohol units can be confusing, particularly as the strength of alcoholic beverages changes over time, and the size of glasses differs. In the UK, the labels containers of alcohol tend to specify the number of units therein and are a useful source of information. In addition, for example:
- 1 standard glass of 13% wine (175ml) is 2.3 units
- 1 large glass of wine (250ml) is 3 units
- 1 bottle of wine is 10 units
- 1 standard measure (25ml) of spirits (40%) is 1 unit (but a home measure is usually much, much more….)
- 1 pint of 4% beer is 2.3 units
- 1 330ml bottle of premium lager (5%) is 1.7 units
How can I tell if alcohol is harming my liver?
Like many liver diseases, alcohol-related liver disease may develop silently over time and the first symptoms can occur when the liver starts to fail and much damage is irreversible. Sometimes liver blood tests may pick up abnormalities incidentally which are the first signs of a problem.
If you notice yellowing of the skin or the eyes (jaundice), swelling of the abdomen or legs, this might indicate that the liver is starting to fail and you should seek urgent medical attention.
If you think you may be drinking too much, a FibroScan® is a very helpful way to see whether you have accumulated damage (fibrosis or scarring) in the liver. You can ask your doctor to arrange or refer you for FibroScan®.
How is ARLD diagnosed?
ARLD can be diagnosed in someone with a history of drinking too much alcohol on the basis of abnormal liver blood tests and/or changes on an ultrasound scan. Often a screen of blood tests is sent to exclude other cause of abnormal liver tests.
Alcoholic hepatitis is often defined as the development of new jaundice in the context of recent heavy alcohol intake and often occurs on a background of cirrhosis. A liver biopsy may be recommended to establish the diagnosis fully.
How is ARLD treated?
Perhaps unsurprisingly, the most important treatment is to stop drinking alcohol. If the liver disease is severe, then long term abstinence from alcohol is essential. If the liver disease is mild and there is no history of alcohol dependency, then a few weeks of abstinence followed by resumption of alcohol within recommended guidelines may be sufficient. A healthy diet and lifestyle are central to recovery.
Vitamins, particularly thiamine, are important to protect the brain and nervous system from alcohol related damage.
In severe alcoholic hepatitis, the patient is at risk of dangerous complications including infections/sepsis, kidney failure and bleeding. The management is usually initiated in hospital and may involve numerous medical interventions and a prolonged stay if some cases.
How should I go about stopping drinking alcohol safely?
Stopping alcohol suddenly when you are accustomed to drinking heavily can be dangerous, leading to withdrawal symptoms ranging from agitation and tremor through to delirium tremens (“DTs”) which can be dangerous can be associated with withdrawal seizures. You should seek advice from your doctor, or contact local alcohol services including Alcoholics Anonymous and, in the Oxfordshire region, Turning Point.
For further information, please see the British Liver Trust pages.