Answers
What is alcoholic hepatitis, and how is it treated?
Short answer
Alcoholic hepatitis is a sudden, serious inflammation of the liver in people who drink heavily, usually for years. It causes jaundice, fever, a tender liver and weakness, and severe cases can be life-threatening. Stopping alcohol completely is the most important treatment, and severe cases need hospital care, sometimes with steroid medicines.
Symptoms
Symptoms usually start while a person is still drinking heavily, or within a few weeks of stopping.
- Yellow eyes and skin (jaundice), often appearing over a few weeks
- Loss of appetite, nausea and severe weakness
- Fever, and pain or tenderness in the upper right belly
- Swelling of the belly or legs from fluid
- In severe cases: confusion, drowsiness, easy bruising or bleeding
Who gets it
Many people with alcoholic hepatitis already have fatty liver or cirrhosis without knowing it.
- People who drink heavily every day for years, often with binges on top
- Women can develop it at lower amounts of alcohol than men
- Being overweight, or having hepatitis B or C, raises the risk
How it is diagnosed
The diagnosis is based on the drinking history, examination and blood tests: bilirubin, liver enzymes, clotting (INR), blood counts and kidney function. An ultrasound and tests for viral hepatitis, infection and a blocked bile duct rule out other causes. Doctors use severity scores, such as the Maddrey score and MELD, to decide who needs stronger treatment. A liver biopsy is sometimes needed when the picture is unclear.
Treatment
Avoid herbal or 'liver detox' remedies, which can harm an already inflamed liver.
- Stop alcohol completely and for life. This matters more than any medicine.
- Moderate and severe cases are treated in hospital.
- Good nutrition is essential; when eating is poor, feeding through a soft tube may be used.
- Infections, kidney problems and alcohol withdrawal are treated, with withdrawal managed safely under medical care.
- Steroid medicines help selected patients with severe disease, once infection has been ruled out, and the response is checked after about a week.
- Liver transplantation is considered in carefully selected patients at specialist centres.
Outlook, and when it is an emergency
Mild alcoholic hepatitis often improves over weeks to months once alcohol is stopped. Severe alcoholic hepatitis is life-threatening: even with treatment, about 1 in 3 people may not survive the following three months. Long-term recovery depends above all on staying off alcohol.
Go to the nearest emergency department or call 112 for confusion or drowsiness, vomiting blood or black stools, high fever, or passing very little urine. Ask your doctor about de-addiction support; help is available and works best with family involvement.
Diet in alcoholic hepatitis
Eat more
- Small meals every 2 to 3 hours, with a bedtime snack such as milk, curd or a banana
- Protein at every meal: dal, curd, paneer, eggs, fish or chicken
- Soft, easy foods when appetite is poor: khichdi, dalia, idli, soups, milk shakes
- Nutrition drinks or tube feeding if advised, when eating is not enough
Cut down
- Alcohol in any form, including beer and wine, for life
- Extra salt, pickles, papad and packaged snacks if there is swelling
- Herbal, Ayurvedic or 'liver tonic' products unless your liver doctor approves
Good to know
- Most people with alcoholic hepatitis are undernourished. Eating well is part of the treatment, not an extra.
- Do not cut down protein; the liver needs it to repair.
Common questions
Can the liver recover after alcoholic hepatitis?
Yes, often. Mild and moderate cases can improve a lot over weeks to months once alcohol is stopped completely. If cirrhosis has already formed, that scarring stays, but the liver can still work much better.
Is it safe to drink a little once I recover?
No. After alcoholic hepatitis, any return to drinking carries a high risk of another, more severe attack. Lifelong abstinence is advised.
How can the family help with stopping alcohol?
Remove alcohol from the home, come to visits together, and ask your doctor about de-addiction care and medicines that reduce craving. Do not stop alcohol suddenly at home after heavy drinking without medical advice, as withdrawal can be dangerous.