Alcohol-Associated Liver Disease

What is alcohol-associated liver disease?

Alcohol-associated liver disease is when your liver becomes damaged over time from drinking alcohol. Alcohol can:

• Harm liver cells
• Cause inflammation 
• Lead to scarring

These changes mean your liver can’t work properly. Alcohol-associated liver disease is one of the most common causes of chronic liver disease and a leading cause of liver-related death.

Alcohol-associated liver disease often happens in stages:

• Fatty liver disease: At first, fat builds up in the liver (this can reverse if alcohol use is discontinued)
• Cirrhosis: If heavy drinking continues, permanent and irreversible liver damage occurs

Some individuals may also develop a more severe form of liver injury known as alcohol-associated hepatitis. Many of these individuals have underlying cirrhosis however they are less likely to recover. 

Not everyone who drinks alcohol develops liver disease. However, heavy or long-term drinking increases your risk.

Causes and risk factors

Your liver processes and breaks down alcohol. Alcohol-associated liver disease happens when your liver is exposed to alcohol repeatedly.

Risk factors may include:

• Heavy alcohol use, which is more than two standard drinks per day for men or more than one for women
• Binge drinking, which is five or more drinks in about two hours for men and four or more for women
• Drinking large amounts of alcohol over many years
• Starting heavy drinking at a young age
• Being female, since alcohol may affect women’s livers more quickly
• Poor nutrition
• Obesity
• Metabolic conditions
• Diabetes
• High blood pressure
• Increased waist size
• Other types of liver diseases, such as viral hepatitis 
• Genetics or family history that makes liver damage from alcohol more likely
• Smoking tobacco

You can get alcohol-associated disease even if you are not alcohol-dependent. Many people who drink excessively do not have alcohol use disorder.

Signs and symptoms

Symptoms of alcohol-associated liver disease can range from mild to severe, depending on the stage of disease.

With early symptoms you may notice:

• Fatigue
• Loss of appetite
• Nausea
• Abdominal discomfort
• Pain in the upper right side of the abdomen

Symptoms of more advanced disease may include:

• Yellowing of the skin or eyes (jaundice)
• Swelling in the belly or legs
• Easy bruising or bleeding
• Confusion or trouble thinking clearly
• Unexplained weight loss
• Muscle weakness
• Mood changes
• Trouble sleeping
• Fever
• Spider-like blood vessels on the skin
• Black, tarry or bloody stools, which can be a sign of bleeding in the digestive tract 

You should get care immediately for severe jaundice, confusion, vomiting blood, sudden swelling or black, tarry or bloody stools. These symptoms can be signs of an emergency.

How alcohol-associated liver disease is diagnosed

Doctors diagnose alcohol-associated liver disease by having a detailed discussion of alcohol use patterns. They will also ask about any other liver problems and your family history of liver conditions. They will perform a physical exam to check for signs and symptoms of liver disease such as an enlarged liver or spleen.

They may also order diagnostic tests, such as:

• Blood tests to check your liver function
• Imaging tests like ultrasound, CT or MRI 
• Transient elastography, an ultrasound that measures liver stiffness
• Upper endoscopy to look for enlarged veins in the esophagus
• Liver biopsy in select cases

These tests help determine the extent of liver damage and guide treatment.

Treatment and care

The most important step in treating alcohol-associated liver disease is stopping alcohol use. Avoiding alcohol can slow or even reverse early liver damage and keep it from getting worse.

It’s best to start liver disease treatment early. Fat buildup in the liver can start to get better soon after you stop drinking alcohol. But scar tissue is permanent, and excessive scar tissue in the liver can lead to cirrhosis.

Treatment may include:

• Support to stop drinking, including counseling or structured addiction treatment programs that can help you safely withdraw from alcohol, reduce cravings and keep you from returning to drinking alcohol
• Medications to reduce inflammation or manage symptoms
• Dietary counseling and, when needed, nutrition support to correct any nutrient deficiencies and help you heal
• Monitoring your liver function regularly
• Evaluation for liver transplant if you have advanced cirrhosis or liver failure and other treatments are not working

If you have more advanced disease, you may need specialized liver care from a multidisciplinary team that may include liver specialists, addiction medicine experts, psychiatrists, nutrition experts and transplant specialists.

Complications and advanced disease

Without treatment, alcohol-associated liver disease can cause serious complications, including:

• Cirrhosis
• Liver failure
• Internal bleeding
• Severe infections
• Increased risk of liver cancer 
• Hepatic encephalopathy (toxin buildup in the brain)
• Kidney failure
• Breathing problems 

Getting diagnosed early and stopping alcohol use can significantly reduce these risks.

When to talk to a specialist

You may be referred to a gastroenterologist (digestive system specialist) or hepatologist (liver specialist) if:

• Your liver tests are abnormal
• Your symptoms stay the same or get worse
• Your doctor thinks you may have cirrhosis or liver failure
• You need coordinated liver and behavioral health support

Multidisciplinary specialist care can help you manage any complications and support your recovery.

Find care at Banner Health

At Banner Health, we offer comprehensive care for alcohol-associated liver disease. We combine liver expertise with supportive services to help you protect your liver health. We can help you understand whether your liver disease is reversible and support your efforts to stop drinking alcohol.

Schedule an appointment with a liver specialist near you.