Alcoholic liver disease

Alcoholic Liver Disease (ALD) is a serious and potentially life-threatening condition that results from prolonged and excessive consumption of alcohol. The liver is a vital organ responsible for detoxifying harmful substances, producing bile for digestion, and storing essential nutrients. However, chronic alcohol use can overwhelm its capacity, leading to progressive liver damage.

ALD encompasses a spectrum of liver disorders ranging from simple fatty liver (steatosis) to alcoholic hepatitis and ultimately cirrhosis. Early detection and intervention are crucial to halting disease progression and improving outcomes.

Alcoholic Liver Disease refers to the damage and inflammation of the liver caused by excessive alcohol intake. It typically progresses through three stages:

1. Alcoholic Fatty Liver (Steatosis): Early and reversible accumulation of fat in liver cells.
2. Alcoholic Hepatitis: Inflammation of the liver with symptoms like jaundice, fever, and abdominal pain.
3. Alcoholic Cirrhosis: Irreversible scarring of the liver that impairs its function.

If left untreated, ALD can lead to liver failure, gastrointestinal bleeding, and increased risk of liver cancer.

Global Prevalence

Globally, ALD remains one of the leading causes of chronic liver disease. According to the World Health Organization (WHO), alcohol contributes to 3 million deaths each year, many of which involve liver disease. Alcoholic cirrhosis accounts for 30-50% of all cirrhosis cases worldwide.

Prevalence in India

In India, ALD is a growing public health concern, particularly with increasing alcohol use among younger populations. It is estimated that ALD accounts for approximately 34% of liver cirrhosis cases in India.

ALD can be categorised into the following types or stages:

• Alcoholic Fatty Liver Disease (AFLD): Often asymptomatic and reversible with abstinence.
• Alcoholic Hepatitis: Ranges from mild to severe, potentially fatal if not treated promptly.
• Alcoholic Cirrhosis: Final and irreversible stage marked by liver fibrosis and dysfunction.
   

• Chronic Alcohol Consumption: Primary cause, especially with daily intake exceeding 40 grams for men and 20 grams for women.
• Genetic Susceptibility: Certain genetic variants increase vulnerability.
• Malnutrition: Alcohol interferes with nutrient absorption, worsening liver damage.
• Gender: Women are more susceptible due to lower levels of alcohol dehydrogenase enzyme.
• Other Liver Conditions: Co-existing diseases like hepatitis C increase risk.
   

Early Symptoms (Fatty Liver)

• Often asymptomatic
• Fatigue
• Mild abdominal discomfort

Alcoholic Hepatitis

• Yellowing of skin and eyes (jaundice)
• Abdominal pain
• Fever
• Loss of appetite
• Nausea and vomiting
• Swelling in legs and abdomen

Alcoholic Cirrhosis

• Severe fatigue
• Confusion (hepatic encephalopathy)
• Bruising and bleeding easily
• Spider-like blood vessels on skin
• Weight loss
• Liver failure signs
   

Diagnosis includes a combination of clinical history, physical examination, laboratory tests, and imaging.

• Medical History: Alcohol intake, family history, past illnesses.
• Blood Tests: Liver function tests (ALT, AST), bilirubin, INR.
• Imaging: Ultrasound, CT scan, FibroScan to assess liver texture.
• Liver Biopsy: Confirms extent of liver damage, especially in ambiguous cases.
   

Immediate Measures

• Complete Abstinence from Alcohol: Critical for recovery.
• Nutritional Support: High-protein, vitamin-rich diet.

Medications

• Corticosteroids: For severe alcoholic hepatitis. (Brand: Agsone 14mg Tablet)
• Pentoxifylline: Reduces inflammation.
• Vitamin B Complex and Folic Acid: For malnutrition. (Brand: Ultrafolin Tablet)

Advanced Treatments

• Liver Transplant: Considered in end-stage liver disease.
• Psychological Therapy: To address alcohol dependence.
   

Alternative treatments may complement conventional therapy but should never replace medical treatment.

• Ayurveda: Liver detox formulations like Kutki, Bhumyamalaki.
• Yoga and Pranayama: Support liver function and mental well-being.
• Acupuncture: May reduce alcohol cravings.

Always consult a doctor before starting alternative treatments.

• Long-term alcohol consumption
• Family history of liver disease
• Co-existing viral hepatitis
• Poor nutrition
• Female sex
• Obesity

• Liver failure
• Portal hypertension and variceal bleeding
• Hepatic encephalopathy
• Ascites and peritonitis
• Liver cancer (Hepatocellular carcinoma)
• Multi-organ failure

• Stay Sober: Join alcohol cessation programs.
• Healthy Diet: Focus on whole grains, fruits, lean protein.
• Routine Monitoring: Regular liver function and imaging tests
• Mental Health: Seek counselling or group therapy.
• Stay Informed: Understand your condition and treatment plan.
   

• Myth: Only heavy drinkers get ALD.
   Fact: Even moderate but consistent drinking can cause damage.
• Myth: Liver damage is always reversible.
   Fact: Cirrhosis is permanent; early stages may be reversible.
• Myth: Symptoms appear immediately.
   Fact: Early stages can be silent for years.
   

Seek medical help if you experience:

• Persistent fatigue
• Yellowing of skin/eyes
• Loss of appetite
• Swelling in abdomen or legs
• Mental confusion

• What stage is my liver disease?
• Can I reverse the damage?
• What tests do I need?
• Are medications necessary?
• What lifestyle changes should I make?
• Do I need to see a specialist?
   

• Be Supportive: Avoid judgement and blame.
• Encourage Sobriety: Help find alcohol cessation programs.
• Attend Appointments: Provide logistical and emotional support.
• Educate Yourself: Learn about ALD to better assist.
• Promote Healthy Habits: Nutritious meals, activity, and hydration.
   

Alcoholic Liver Disease is a progressive and potentially fatal condition caused by long-term alcohol abuse. While it can be asymptomatic in the early stages, timely diagnosis and complete abstinence from alcohol can slow or halt disease progression. Managing nutrition, addressing alcohol dependence, and consistent medical follow-up are key to living well with ALD. With proper support and lifestyle changes, many people with ALD can maintain a functional and fulfilling life.