STATEN ISLAND, N.Y. — The liver is one of the major and complex organs in the body, which performs many of the body’s vital functions. Alcohol is metabolized in the liver so that it can be eliminated safely from the body.
Alcoholic liver disease usually occurs after years of excessive drinking and will reduce the quality of life for patients and for their families as well. Liver cirrhosis is one of the leading causes of death in the United States.
There are individual variations in the development of liver disease among those who drink heavily. One should drink sensibly and in moderation, as there may not be many signs or symptoms until the liver damage has been done.
3 KINDS OF LIVER DISEASE
What constitutes alcoholic liver disease?
Heavy alcohol consumption causes three kinds of liver diseases:
1. Simple uncomplicated fatty liver (Steatosis)
2. Fatty liver with inflammation (Alcoholic Hepatitis or Steatohepatitis), and
Fatty liver is the earliest stage of liver disease marked by accumulation of fat in the liver cells. This occurs almost in all people who drink heavily. Apart from occasional right upper abdominal discomfort due to enlarged liver, there may not be any significant symptoms. Fatty liver does not cause serious damage to liver function and these changes are reversible if alcohol consumption is stopped.
Continued drinking may lead to more severe involvement called alcoholic hepatitis. About 10 to 35 percent of heavy drinkers develop the condition. The liver becomes inflamed and, in its milder, form will cause progressive liver damage and may last for years before it develops into cirrhosis. In its severe form, binge drinking can cause acute alcoholic hepatitis within a few days, with liver failure and life-threatening complications. Patients may feel nauseated, may have vomiting, fever, abdominal pain, jaundice and even a change in mental status. This stage is also reversible and patients may recover completely, provided no further insult occurs with alcohol.
Liver cirrhosis is the more serious form of alcoholic liver disease and is irreversible. At this stage healthy liver tissues are replaced by scar tissues and the liver is not able to perform its normal vital functions.
About 10 to 20 percent of heavy drinkers usually develop cirrhosis after 10 or more years. Generally, drinking 80 grams of ethanol daily for 10 to 20 years is required to develop cirrhosis which corresponds to approximately one liter of wine, eight standard sized beers, or one half pint of hard liquor each day.
Progression is more rapid particularly in those who have Hepatitis C or any other chronic liver disease. Symptoms vary depending on the severity of the disease and also the complications of cirrhosis. Apart from symptoms similar to alcoholic hepatitis, one can develop more serious complications such as accumulation of fluid in the abdomen (ascites), bleeding from esophageal or stomach veins, kidney failure, liver cancer or significant liver failure and show signs of acute changes in mental status and possibly coma. No cure exists for liver cirrhosis and the liver will never be normal again.
DIAGNOSIS & TREATMENT
A long history of alcohol use is the best indicator of the disease. Physical signs and lab tests with elevated liver enzymes, imaging in the form of ultrasound, CAT or MRI scans may help in diagnosis and to rule out other causes of liver disease. Though the liver biopsy is the gold standard for diagnosis, it is not always necessary.
Completely stopping the consumption of alcohol and lifestyle changes are the cornerstone to preventing further progression of the disease. Smoking cessation and maintaining healthy weight are equally important. Alcohol rehabilitation programs may be helpful and joining support groups may ease the stress associated with the illness.
Many alcoholics take less than recommended amounts of nutrients and are malnourished. Some of the supplements (vitamin B1, B2, B6, folic acid, and medium chain fatty acids) may prevent the serious effects of alcohol to some extent.
No therapy exists for either alcoholic hepatitis or cirrhosis. Steroids have been studied for short-term use in severe alcoholic hepatitis with varying results. Liver transplantation is the only definitive treatment for severe liver failure. It is essential to remain abstinent before and after surgery and to comply with medications.
Alcohol use has also been associated with oropharyngeal and esophageal cancers, liver cancer, pancreatitis, osteoporosis and increased risk of accidental and suicidal deaths.
Dietary guidelines for Americans recommend no more than one drink per day for women and no more than two drinks per day for men. It is wise to have a few alcohol-free days in a week. Drinking alcohol in moderation is the key to enjoying alcohol responsibly. Anyone with liver disease who stops drinking improves his health and life expectancy. Those who do not stop will have a poor outlook and will likely suffer from a variety of complications of alcohol-induced liver disease.