Introduction
Alcoholic hepatitis is inflammation of the liver driven by heavy alcohol use. It can appear suddenly after a period of intense drinking, often in someone who already has underlying alcohol-related liver injury, and ranges from mild enzyme elevation to life-threatening liver failure.
Typical features include loss of appetite, nausea, abdominal pain or swelling, jaundice or pale-looking illness, profound fatigue, and in severe disease confusion or combined liver–kidney failure.
Diagnosis rests on drinking history, exam, liver blood tests, imaging, and sometimes liver biopsy when the picture is unclear. Infection, drug injury, and viral hepatitis must be considered as alternatives or co-factors.
The essential treatment is lasting abstinence, nutritional support, and selected medicines for severe inflammation in carefully chosen patients. Transplant is considered when recovery is impossible and selection criteria are met. Early specialist care improves survival odds.
Overview
Alcoholic hepatitis is a clinical syndrome of steatohepatitis related to alcohol, not a single lab number. Severity scores help estimate short-term mortality risk.
Stopping alcohol is the only intervention that reliably reverses ongoing toxic injury. Continued drinking after an episode strongly predicts worsening cirrhosis and death.
Care teams often include hepatology, nutrition, addiction services, and intensive care when organ failure develops.
- Alcohol-driven liver inflammation, often on a background of chronic use
- Symptoms scale with how much liver injury has occurred
- Jaundice, tender hepatomegaly, and systemic illness are common in moderate–severe cases
- Labs, imaging, and sometimes biopsy guide diagnosis
- Abstinence + nutrition are foundational; steroids only in selected severe cases
- Transplant evaluation for refractory end-stage disease under strict criteria
What happens in the body
Ethanol and its metabolites injure hepatocytes, trigger oxidative stress and inflammation, and promote fat accumulation and ballooning injury typical of steatohepatitis.
Severe inflammation impairs the liver’s synthetic and detoxifying functions—coagulation factors fall, bilirubin rises, and toxins and infections become harder to clear—setting the stage for ascites, encephalopathy, and multi-organ failure.
- Toxic and inflammatory injury from heavy ethanol exposure
- Often overlaps with steatosis and evolving fibrosis/cirrhosis
- Malnutrition worsens immune and healing capacity
- Gut barrier changes increase infection risk in severe disease
- Kidney injury may accompany advanced hepatic failure
Signs and symptoms
Features vary with the amount of liver damage. Common and severe signs include:
- Loss of appetite
- Unintentional weight loss
- Nausea and vomiting
- Abdominal pain or swelling (ascites)
- Jaundice (yellow skin/eyes) or a sallow, pale appearance
- Fatigue and marked weakness
- Fever or feeling systemically unwell
- Tender enlarged liver in some patients
- Easy bruising or bleeding tendency in advanced disease
- Confusion or sleep-wake reversal (encephalopathy)
- Dark urine and pale stools when cholestasis is prominent
- Swelling of legs
- In severe cases: liver failure and acute kidney injury
- Increased infection susceptibility (e.g., spontaneous bacterial peritonitis risk with ascites)
Causes and risk factors
Heavy alcohol intake is required. Additional contributors include:
- Sustained heavy daily drinking or repeated binge patterns
- Recent increase in intake on top of chronic use
- Female sex and genetic factors influencing alcohol metabolism (higher vulnerability in some)
- Obesity and metabolic syndrome overlapping with fatty liver
- Malnutrition and vitamin deficiencies
- Concurrent viral hepatitis or other liver toxins/drugs
- Prior episodes of alcohol-related liver disease
- Not caused by casual rare social drinking in isolation—but any amount is unsafe once alcoholic hepatitis is diagnosed
Diagnosis and evaluation
Clinicians integrate history with laboratory and imaging findings; biopsy is selective:
- Careful alcohol-use history (amount, duration, last drink) plus collateral history
- Physical exam for jaundice, ascites, encephalopathy, and stigmata of chronic liver disease
- Liver function tests and bilirubin; coagulation (INR) for synthetic function
- Complete blood count and kidney function tests
- Ultrasound, CT, or MRI to assess liver structure, exclude biliary obstruction, and look for ascites/HCC when relevant
- Infection workup—cultures and ascitic fluid analysis when fever or peritonitis is possible
- Liver biopsy when diagnosis remains uncertain or competing causes must be excluded
- Severity scoring (e.g., Maddrey DF, MELD-based tools) to guide prognosis and therapy decisions
Treatment and management
Management centres on stopping alcohol, feeding the patient, treating complications, and considering anti-inflammatory therapy only when criteria are met:
- Immediate and sustained alcohol cessation with medical and psychosocial support (medicines, counselling, groups, residential programmes as needed)
- High-calorie, high-protein nutrition when appropriate; dietitian-guided plans
- Enteral tube feeding if the patient cannot maintain oral intake
- Thiamine and other vitamin repletion before glucose in at-risk patients
- Corticosteroids for carefully selected severe alcoholic hepatitis without contraindications (infection, uncontrolled GI bleed, etc.)
- Pentoxifylline is less often first-line in modern practice; follow current specialist guidance
- Treat ascites, encephalopathy, infections, and kidney injury supportively
- Avoid hepatotoxic drugs and unnecessary sedatives
- Liver transplant evaluation for non-recovering severe disease meeting centre criteria
- Long-term relapse prevention after the acute episode
Prevention, self-care, and lifestyle
Not every condition is fully preventable, but the steps below may lower risk or recurrence:
- Abstain completely after any diagnosis of alcoholic hepatitis
- Seek treatment for alcohol use disorder before irreversible cirrhosis develops
- Maintain nutrition; avoid crash diets during recovery
- Vaccinate for hepatitis A/B when indicated and avoid other liver insults
- Regular hepatology follow-up and ultrasound surveillance if cirrhosis is present
- Family education to recognise jaundice, confusion, and fever early
Possible complications
Delay, missed care, or unsafe self-medication can raise the chance of complications in some cases:
- Acute liver failure phenotype with high short-term mortality
- Hepatorenal syndrome and fluid/electrolyte crises
- Variceal bleeding and coagulopathy-related haemorrhage
- Spontaneous bacterial peritonitis and sepsis
- Hepatic encephalopathy and aspiration
- Progression to cirrhosis and hepatocellular carcinoma risk over time
- Malnutrition and muscle wasting (sarcopenia)
When to see a doctor or seek emergency care
Seek prompt medical advice or emergency care if any of the following apply—it is safer not to wait and see:
- Jaundice, severe abdominal swelling, or confusion after heavy drinking
- Vomiting blood, black stools, or unusual bruising
- Fever with ascites or severe abdominal tenderness
- Inability to eat or drink with rapid weakness
- Known liver disease with any return to alcohol use
- Reduced urine output, extreme drowsiness, or fainting
Living with the condition
Abstinence is both treatment and prevention of the next, often worse, episode. Build a relapse plan before leaving hospital.
Work with a dietitian; many patients need structured calories and protein despite poor appetite.
Coordinate addiction care with liver clinics so craving treatment and hepatology visits reinforce each other.
Frequently asked questions
Is alcoholic hepatitis the same as cirrhosis?
No. Hepatitis is active inflammation; cirrhosis is advanced scarring. They often coexist, and repeated hepatitis accelerates cirrhosis.
Can the liver heal if I stop drinking?
Mild to moderate injury may improve substantially with abstinence and nutrition. Severe disease can still be fatal even after stopping—urgent care matters.
Why is nutrition emphasised?
Heavy drinkers are often calorie-protein deficient. Refeeding under guidance supports immune function and hepatic recovery.
Do steroids cure alcoholic hepatitis?
They may help selected severe cases short-term but are not a cure and are unsafe if active infection or other contraindications exist. Abstinence remains essential.
When is transplant considered?
When the liver will not recover despite optimal care and the patient meets medical and abstinence-related selection criteria at a transplant centre.
Can I return to “moderate” drinking later?
After alcoholic hepatitis, the safest medical advice is lifelong abstinence—there is no reliably safe level for that liver.
Important caution
This article is for general health education only and is not personal hepatology advice.
Jaundice, confusion, vomiting blood, or fever with abdominal swelling need emergency care.
Decisions about steroids, feeding tubes, or transplant require a specialist who knows your full case.