Author: David Vaz
Editor: Leah Farquharson
Overview
Alcoholic hepatitis (AH) refers to the inflammation of the liver due to prolonged, and heavy alcohol use (Im, 2019). Originally thought to be caused by malnutrition, AH is now known to be caused by toxic chemicals produced by the liver as a result of alcohol degradation (Im, 2019). Signs of AH include jaundice, abdominal pain, malnutrition, and changes in mental status accompanied by heavy drinking (Hosseini et al., 2019). Although there is no minimum threshold for drinking, common parameters are at least 3 drinks per day for women and 4 drinks per day for men for a period of more than 6 months (Hosseini et al., 2019).
Treatment mainly revolves around abstinence and nutritional supplementation (Hosseini et al., 2019). More severe cases may require corticosteroid administration and/or liver transplantation (Hosseini et al., 2019).
Symptoms
Symptoms of AH include:
- Jaundice (yellowing of skin and whites of eyes),
- Abdominal pain,
- Fullness or distention,
- Fever,
- GI bleeding,
- Changes in mental status,
- Malnutrition (Hosseini et al., 2019).
Risk Factors
The primary risk factor for AH is heavy alcohol use (Im, 2019). While no minimum threshold for alcohol consumption currently exists, common parameters are at least 3 drinks per day for women and 4 drinks per day for men for more than 6 months (Im, 2019). Independently, alcohol abuse does not necessitate the development of clinically important alcoholic liver disease (ALD), as only 10-20% of chronic heavy drinkers develop severe forms of AH (Singal et al., 2018). As such, environmental/genetic factors are thought to play a role (Singal et al., 2018). Some of these factors include:
- Sex: Females are at risk of AH at a lower daily dosage of alcohol because of higher percent body fat and different alcohol-processing mechanisms (Singal et al., 2018).
- Obesity: In one study, obesity was found to be the main factor in determining the risk for cirrhosis (a life-threatening condition that may follow AH) among heavy drinkers (Singal et al., 2018).
- Smoking: Cigarette smoking is common among alcoholic patients, and it can often augment the effects of alcohol, favoring more severe forms of AH (Singal et al., 2018).
- Concomitant conditions: The presence of HIV or viral hepatitis can influence the progression and severity of AH (Singal et al., 2018).
- Genetics: Some studies have suggested a potential genetic factor for increased susceptibility to AH (Singal et al., 2018).
Types of alcoholic beverages (Ex. beer, wine, spirits), as well as drinking patterns (ex. Binge drinking) having an effect on the development of AH, do not have significant evidence in recent studies (Singal et al., 2018).
How does my doctor know I have Alcoholic Hepatitis?
One of the most important diagnostic criteria for AH is a history of prolonged, heavy alcohol use (Singal et al., 2018). Therefore, it is important to be honest with your provider about your drinking history (Singal et al., 2018). If symptoms are present, a provider may undergo a physical examination to check for less visible symptoms such as an enlarged liver, mild fever, and/or abdominal bruit (abnormal murmuring sound from blocked blood vessels) (Singal et al., 2018). Your provider may order tests to be done to monitor the levels of toxins in your blood (Singal et al., 2018).
Your healthcare provider may also request further testing such as abdominal imaging (ultrasound, CT, MRI) and/or a liver biopsy to confirm the diagnosis (Singal et al., 2018).
Treatment
Based on the diagnostic tests performed your provider will determine the severity of AH (Hosseini et al., 2019). Treatment may vary depending on the severity of AH (Hosseini et al., 2019). A common theme across all treatment plans is a patient’s elimination or reduction of alcohol intake (Hosseini et al., 2019). Due to the nature of addiction, the abstinence of alcohol can be aided via clinical means through formal enrollment in Alcoholics Anonymous (AA) programs, CBT therapy and other psychotherapy, motivational counseling, and drugs such as Acamprosate and Naltrexone to mitigate cravings (Hosseini et al., 2019).
For moderate AH treatment, abstinence from alcohol continues to be the only approved method of treatment, although other therapies are currently in clinical trials (Im et al., 2019). Nutritional therapies may be useful to ameliorate malnourishment caused by excessive alcohol intake (Im et al., 2019).
Severe AH treatment primarily involves daily administration with the drug Prednisolone over the span of about a month (Im et al., 2019). In addition, nutritional intake of at least 3000 daily calories has also been associated with increased survival (Im et al., 2019). In the most severe cases, liver transplantation may also be a course of treatment (Im et al., 2019).
References
Hosseini, N., Shor, J., & Szabo, G. (2019). Alcoholic Hepatitis: A Review. Alcohol and Alcoholism, 54(4), 408–416. DOI: 10.1093/alcalc/agz036.
Im, G. Y. (2019). Acute Alcoholic Hepatitis. Clinics in Liver Disease, 23(1), 81–98. DOI: 10.1016/j.cld.2018.09.005.
Im, G. Y., Cameron, A. M., & Lucey, M. R. (2019). Liver transplantation for alcoholic hepatitis. Journal of Hepatology, 70(2), 328–334. DOI: 10.1016/j.jhep.2018.11.007.
Singal, A. K., Bataller, R., Ahn, J., Kamath, P. S., & Shah, V. H. (2018). ACG Clinical Guideline: Alcoholic Liver Disease. American Journal of Gastroenterology, 113(2), 175–194. DOI: 10.1038/ajg.2017.469.Singal, A. K., Louvet, A., Shah, V. H., & Kamath, P. S. (2018). Grand Rounds: Alcoholic Hepatitis. Journal of Hepatology, 69(2), 534–543. DOI: 10.1016/j.jhep.2018.05.001.
