Table of ContentsView AllTable of ContentsCausesSymptomsDiagnosisComplicationsLife ExpectancyTreatmentCopingSupport
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Diagnosis
Complications
Life Expectancy
Treatment
Coping
Support
The symptoms of alcoholic hepatitis are similar toother forms of hepatitis, including fatigue, nausea, upper-right abdominal pain, andjaundice(yellowing of the skin and eyes). Stopping alcohol can potentially reverse liver injury before it leads tocirrhosis, the most advanced stage of AFLD.
This article explains how alcoholic hepatitis develops and ways to recognize it when it occurs. It also describes how alcoholic hepatitis is treated, including its impact on life expectancy.
Alcohol Consumption and Alcoholic Hepatitis
With that said, alcoholic hepatitis is not dose-dependent. Although alcoholic hepatitis can occur within a relatively short period (particularly in those whobinge drink),it is more often seen in people with a long history of heavy alcohol use, typically those who consume eight to 10 drinks per day for 10 years or more.
A Note on Gender and Sex TerminologyVerywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A Note on Gender and Sex Terminology
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
From Fatty Liver Disease to Alcoholic Hepatitis
Alcoholic hepatitis is a manifestation of alcohol-associated fatty liver disease, also known as alcoholic liver disease. With AFLD, the overconsumption of alcohol causes the accumulation of fat in the liver, known ashepatosteatosis.
While hepatosteatosis is largelyasymptomatic(without symptoms), the underlyinginflammationcan build as the fatty deposits increase, eventually leading to symptoms of hepatitis.
Hepatitis disrupts thenormal function of the liver. Among other things, it speeds up thenormal breakdown of red blood cellsin the liver. This breakdown leads to the excessive release of a yellowish waste product calledbilirubin, which causes jaundice.
Other Risk FactorsAlcoholic hepatitis affects 30% to 40% of people with excessive alcohol consumption.While the amount and duration of drinking influence the risk, other factors can contribute, including:Older age: With symptoms typically starting between the ages of 40 and 50Being female: Due in part to smaller body size and slower metabolism of alcoholObesity: Which speeds the development of hepatosteatosisA history of binge drinking: Especially in younger adults with AFLDMalnutrition: Common in people with alcohol use disorder due to impaired nutrient absorptionGenetics: Including inherited mutations that impair the production of enzymes that metabolize alcohol
Other Risk Factors
Alcoholic hepatitis affects 30% to 40% of people with excessive alcohol consumption.While the amount and duration of drinking influence the risk, other factors can contribute, including:Older age: With symptoms typically starting between the ages of 40 and 50Being female: Due in part to smaller body size and slower metabolism of alcoholObesity: Which speeds the development of hepatosteatosisA history of binge drinking: Especially in younger adults with AFLDMalnutrition: Common in people with alcohol use disorder due to impaired nutrient absorptionGenetics: Including inherited mutations that impair the production of enzymes that metabolize alcohol
Alcoholic hepatitis affects 30% to 40% of people with excessive alcohol consumption.While the amount and duration of drinking influence the risk, other factors can contribute, including:
Understanding Fatty Liver Disease
How Do Alcoholic Hepatitis Symptoms Begin?
Signs and symptoms of alcoholic hepatitisinclude:
In severe cases, alcoholic hepatitis can lead to the buildup of fluid in the abdomen, calledascites, and neurological symptoms such as confusion, reduced alertness, and personality changes due tohepatic encephalopathy. Both are signs of severe liver dysfunction.
Importance of Early Diagnosis
Recognizing the signs of alcoholic hepatitis is the first step to preventing the progression of liver disease. An extensive evaluation is needed to differentiate AFLD from conditions with similar symptoms, likehepatitis B,hepatitis C,autoimmune hepatitis, ormetabolic dysfunction-associated steatohepatitis (MASH).
Medical Review and Physical Exam
The diagnosis of alcoholic hepatitis starts with a review of your medical history and a physical exam.
During the physical exam, the healthcare provider will look for other signs, such asspider angioma(spider veins),palmar erythema(palm redness),tachycardia(rapid heartbeat),tremors, andperipheral edema(swelling of the ankles and feet). All of these are common in people withalcohol use disorder(alcoholism).
The provider will also ask questions to determine if alcohol is the likely cause, including:
Lab Tests and Procedures
Based on the initial findings, your healthcare provider will order tests to help firmly establish AFLD as the cause of your symptoms.
These typically include:
Other procedures may be ordered to characterize the severity of AFLD and determine if cirrhosis is present:
MELD Scoring
MELD scores range from 6 for mild liver dysfunction to 40 for severe liver disease. MELD scores can also predict the likely outcome (prognosis) of treatment.
What Are Signs of Liver Disease?
Reversing Alcoholic Hepatitis
Continued heavy drinking can increase the risk of cirrhosis, which largely is irreversible.
Cirrhosis is considered compensated when the liver is still functional. When the damage is so extensive as to causeliver failure, you are said to have decompensated cirrhosis. With end-stage liver disease, aliver transplantis the only means of survival.
Common Complications of Cirrhosis
Effect on Life Expectancy
Though alcoholic hepatitis is largely reversible once drinking is stopped, it is not always so. In some people, the damage can be permanent and even deadly.
In cases of severe alcoholic hepatitis, an extreme drop in platelets can lead to bleeding in the gastrointestinal tract known asvariceal hemorrhage. Along with ascites and hepatic encephalopathy, variceal bleeding is associated with an increased risk of death.
Studies suggest that severe alcoholic hepatitis is associated with a 180-day mortality (death) rate of 40%. Moreover, it increases the risk of cirrhosis ninefold compared to people with mild hepatitis.
While it may be reasonable to assume that the risk increases with the amount of alcohol you drink, factors like genetics, sex, and weight can predispose you to severe hepatitis at far lower levels.
What Is the Life Expectancy With Cirrhosis?Cirrhosis is linked to reduced life expectancy. Research suggests that the five-year survival rate in the United States is 73%—meaning that 73 out of 100 people will live for at least five years. By 10 years, the survival rate drops to 54%.
What Is the Life Expectancy With Cirrhosis?
Cirrhosis is linked to reduced life expectancy. Research suggests that the five-year survival rate in the United States is 73%—meaning that 73 out of 100 people will live for at least five years. By 10 years, the survival rate drops to 54%.
Predicting Survival
Life expectancy can also be estimated based on MELD scores. The MELD score is typically used to prioritize who gets a liver transplant but can also be useful in determining survival in people with alcoholic hepatitis.
The MELD score predicts life expectancy based on the observed mortality (meaning the percentage of people who will die within a specific time frame). The 90-day observed mortality for alcoholic hepatitis is currently described as follows:
Life Expectancy With Cirrhosis
Alcoholic Hepatitis Treatment
With AFLD, the treatment may involve:
How Liver Disease Is Treated
How to Adapt to Lifestyle Changes Without Alcohol
Quitting alcohol is rarely easy if you have been drinking heavily for years. Alcohol recovery programs are essential for those who can’t quit, including faith-based12-step programslike Alcoholics Anonymous (AA) or science-based programs like SMART Recovery.
Whatever program you choose, these eight tips can help you better adapt to an alcohol-free lifestyle:
What Happens If You Quit Drinking for a Month?
Where to Find Support
Having alcoholic hepatitis can cause extreme stress and fears about the future. It can also trigger feelings of guilt and shame that cause you to isolate yourself, particularly with symptoms like jaundice that you cannot hide.
These are many of the same emotions that cause people to drink excessively—and in secrecy—in the first place. It is for this reason that “going it alone” may not be in your best interest.
While you may not be ready to reach out to family or friends just yet, support symptoms can help you overcome feelings of anxiety and isolation as you embark on treatment.
Two places to start are:
Summary
Mild alcoholic hepatitis may resolve with no lasting injury once drinking is stopped. Severe cases can lead to cirrhosis and liver failure if drinking continues.
The treatment of alcohol hepatitis varies based on the severity of liver injury but invariably involves quitting alcohol. Corticosteroid drugs or a liver transplant may be needed in severe cases.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Im GY.Acute alcoholic hepatitis.Clinics Liver Dis.2019;23:81-98. doi:10.1016/j.cld.2018.09.005Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR.Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance From the American Association for the Study of Liver Diseases.Hepatology. 2020:71(1):306–333. doi:10.1002/hep.30866Stauber RE, Rautou PE, Steranescu H, Horhat A, Thiele M, Lackner C.Validation of NIAAAm-CRP criteria to predict alcohol-associated steatohepatitis on liver histology.JHEP Rep.2024;6(5):101055. doi:10.1016/j.jhepr.2024.101055Dugum MF, McCullough AJ.Acute alcoholic hepatitis, the clinical aspects.Clin Liver Dis.2016;20(3):499–508. doi:10.1016/j.cld.2016.02.008Osna NA, Donohue TM Jr, Kharbanda KK.Alcoholic liver disease: pathogenesis and current management.Alcohol Res. 2017;38(2):147-161.Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.Smith A, Baumgartner K, Bositis C.Cirrhosis: diagnosis and management.Am Fam Physician.2019;100(12):759-770.Keating M, Lardo O, Hansell M.Alcoholic hepatitis: diagnosis and management.Am Fam Physician.2022;105(4):412-420Peng Y, Qi X, Guo X.Child–Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Medicine (Baltimore).2016;95(8):e2877. doi:10.1097/MD.0000000000002877Morgan TR.Treatment of alcoholic liver disease.Gastroenterol Hepatol (NY).2017;13(7):425–427.Nusrat S, Khan MS, Fazili J, Madhoun MF.Cirrhosis and its complications: evidence based treatment.World J Gastroenterol.2014;20(18):5442–5460. doi:10.3748/wjg.v20.i18.5442Phillips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P.Severe alcoholic hepatitis: current perspectives.Hepat Med.2019;11:97–108. doi:10.2147/HMER.S197933Krishtopaytis E, Kumar P, Almomani A, et al..Smoking increases the risk for cirrhosis and esophageal varices among patients with non-alcoholic fatty liver disease.Am J Gastroenterol.2022;117(1OS):e907. doi:10.14309/01.ajg.0000861668.84072.e1Goldberg D, Zarnegarnia Y.Prediction of long-term survival among patients with cirrhosis using time-varying models.Hepatol Commun.2023;7(6):e0185. doi:10.1097/HC9.0000000000000185Kezer CA, Buryska SM, Ahn JC, Kamath PS, Shah VH, Simonetta DA.The mortality index for alcohol-associated hepatitis: a novel prognostic score.Mayo Clinic Proceedings.2022;97(3):P480-480. doi:10.1016/j.mayocp.2021.10.026Casadaban LD, Parvinian A, Zivin SP, et al.MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort.Ann Hepatol.2015;14(3):380-388. doi:10.1016/S1665-2681(19)31278-5McClain CJ, Rios CD, Condon S, Marsano LS.Malnutrition and alcohol-associated hepatitis.Clin Liver Dis.2021;25(3):557–570. doi:10.1016/j.cld.2021.03.002Arab JP, Diaz LA, Baeza N, et al.Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: a worldwide study.J Hepatol.2021;75(5):1026-1033. doi:10.1016/j.jhep.2021.06.019Im GY, Cameron AM, Lucey MR.Liver transplantation for alcoholic hepatitis.J Hepatol.2019;70(2):P328-334. doi:10.1016/j.jhep.2018.11.007
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Im GY.Acute alcoholic hepatitis.Clinics Liver Dis.2019;23:81-98. doi:10.1016/j.cld.2018.09.005Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR.Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance From the American Association for the Study of Liver Diseases.Hepatology. 2020:71(1):306–333. doi:10.1002/hep.30866Stauber RE, Rautou PE, Steranescu H, Horhat A, Thiele M, Lackner C.Validation of NIAAAm-CRP criteria to predict alcohol-associated steatohepatitis on liver histology.JHEP Rep.2024;6(5):101055. doi:10.1016/j.jhepr.2024.101055Dugum MF, McCullough AJ.Acute alcoholic hepatitis, the clinical aspects.Clin Liver Dis.2016;20(3):499–508. doi:10.1016/j.cld.2016.02.008Osna NA, Donohue TM Jr, Kharbanda KK.Alcoholic liver disease: pathogenesis and current management.Alcohol Res. 2017;38(2):147-161.Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.Smith A, Baumgartner K, Bositis C.Cirrhosis: diagnosis and management.Am Fam Physician.2019;100(12):759-770.Keating M, Lardo O, Hansell M.Alcoholic hepatitis: diagnosis and management.Am Fam Physician.2022;105(4):412-420Peng Y, Qi X, Guo X.Child–Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Medicine (Baltimore).2016;95(8):e2877. doi:10.1097/MD.0000000000002877Morgan TR.Treatment of alcoholic liver disease.Gastroenterol Hepatol (NY).2017;13(7):425–427.Nusrat S, Khan MS, Fazili J, Madhoun MF.Cirrhosis and its complications: evidence based treatment.World J Gastroenterol.2014;20(18):5442–5460. doi:10.3748/wjg.v20.i18.5442Phillips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P.Severe alcoholic hepatitis: current perspectives.Hepat Med.2019;11:97–108. doi:10.2147/HMER.S197933Krishtopaytis E, Kumar P, Almomani A, et al..Smoking increases the risk for cirrhosis and esophageal varices among patients with non-alcoholic fatty liver disease.Am J Gastroenterol.2022;117(1OS):e907. doi:10.14309/01.ajg.0000861668.84072.e1Goldberg D, Zarnegarnia Y.Prediction of long-term survival among patients with cirrhosis using time-varying models.Hepatol Commun.2023;7(6):e0185. doi:10.1097/HC9.0000000000000185Kezer CA, Buryska SM, Ahn JC, Kamath PS, Shah VH, Simonetta DA.The mortality index for alcohol-associated hepatitis: a novel prognostic score.Mayo Clinic Proceedings.2022;97(3):P480-480. doi:10.1016/j.mayocp.2021.10.026Casadaban LD, Parvinian A, Zivin SP, et al.MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort.Ann Hepatol.2015;14(3):380-388. doi:10.1016/S1665-2681(19)31278-5McClain CJ, Rios CD, Condon S, Marsano LS.Malnutrition and alcohol-associated hepatitis.Clin Liver Dis.2021;25(3):557–570. doi:10.1016/j.cld.2021.03.002Arab JP, Diaz LA, Baeza N, et al.Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: a worldwide study.J Hepatol.2021;75(5):1026-1033. doi:10.1016/j.jhep.2021.06.019Im GY, Cameron AM, Lucey MR.Liver transplantation for alcoholic hepatitis.J Hepatol.2019;70(2):P328-334. doi:10.1016/j.jhep.2018.11.007
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Im GY.Acute alcoholic hepatitis.Clinics Liver Dis.2019;23:81-98. doi:10.1016/j.cld.2018.09.005Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR.Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance From the American Association for the Study of Liver Diseases.Hepatology. 2020:71(1):306–333. doi:10.1002/hep.30866Stauber RE, Rautou PE, Steranescu H, Horhat A, Thiele M, Lackner C.Validation of NIAAAm-CRP criteria to predict alcohol-associated steatohepatitis on liver histology.JHEP Rep.2024;6(5):101055. doi:10.1016/j.jhepr.2024.101055Dugum MF, McCullough AJ.Acute alcoholic hepatitis, the clinical aspects.Clin Liver Dis.2016;20(3):499–508. doi:10.1016/j.cld.2016.02.008Osna NA, Donohue TM Jr, Kharbanda KK.Alcoholic liver disease: pathogenesis and current management.Alcohol Res. 2017;38(2):147-161.Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.Smith A, Baumgartner K, Bositis C.Cirrhosis: diagnosis and management.Am Fam Physician.2019;100(12):759-770.Keating M, Lardo O, Hansell M.Alcoholic hepatitis: diagnosis and management.Am Fam Physician.2022;105(4):412-420Peng Y, Qi X, Guo X.Child–Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Medicine (Baltimore).2016;95(8):e2877. doi:10.1097/MD.0000000000002877Morgan TR.Treatment of alcoholic liver disease.Gastroenterol Hepatol (NY).2017;13(7):425–427.Nusrat S, Khan MS, Fazili J, Madhoun MF.Cirrhosis and its complications: evidence based treatment.World J Gastroenterol.2014;20(18):5442–5460. doi:10.3748/wjg.v20.i18.5442Phillips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P.Severe alcoholic hepatitis: current perspectives.Hepat Med.2019;11:97–108. doi:10.2147/HMER.S197933Krishtopaytis E, Kumar P, Almomani A, et al..Smoking increases the risk for cirrhosis and esophageal varices among patients with non-alcoholic fatty liver disease.Am J Gastroenterol.2022;117(1OS):e907. doi:10.14309/01.ajg.0000861668.84072.e1Goldberg D, Zarnegarnia Y.Prediction of long-term survival among patients with cirrhosis using time-varying models.Hepatol Commun.2023;7(6):e0185. doi:10.1097/HC9.0000000000000185Kezer CA, Buryska SM, Ahn JC, Kamath PS, Shah VH, Simonetta DA.The mortality index for alcohol-associated hepatitis: a novel prognostic score.Mayo Clinic Proceedings.2022;97(3):P480-480. doi:10.1016/j.mayocp.2021.10.026Casadaban LD, Parvinian A, Zivin SP, et al.MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort.Ann Hepatol.2015;14(3):380-388. doi:10.1016/S1665-2681(19)31278-5McClain CJ, Rios CD, Condon S, Marsano LS.Malnutrition and alcohol-associated hepatitis.Clin Liver Dis.2021;25(3):557–570. doi:10.1016/j.cld.2021.03.002Arab JP, Diaz LA, Baeza N, et al.Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: a worldwide study.J Hepatol.2021;75(5):1026-1033. doi:10.1016/j.jhep.2021.06.019Im GY, Cameron AM, Lucey MR.Liver transplantation for alcoholic hepatitis.J Hepatol.2019;70(2):P328-334. doi:10.1016/j.jhep.2018.11.007
Im GY.Acute alcoholic hepatitis.Clinics Liver Dis.2019;23:81-98. doi:10.1016/j.cld.2018.09.005
Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR.Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance From the American Association for the Study of Liver Diseases.Hepatology. 2020:71(1):306–333. doi:10.1002/hep.30866
Stauber RE, Rautou PE, Steranescu H, Horhat A, Thiele M, Lackner C.Validation of NIAAAm-CRP criteria to predict alcohol-associated steatohepatitis on liver histology.JHEP Rep.2024;6(5):101055. doi:10.1016/j.jhepr.2024.101055
Dugum MF, McCullough AJ.Acute alcoholic hepatitis, the clinical aspects.Clin Liver Dis.2016;20(3):499–508. doi:10.1016/j.cld.2016.02.008
Osna NA, Donohue TM Jr, Kharbanda KK.Alcoholic liver disease: pathogenesis and current management.Alcohol Res. 2017;38(2):147-161.
Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.
Smith A, Baumgartner K, Bositis C.Cirrhosis: diagnosis and management.Am Fam Physician.2019;100(12):759-770.
Keating M, Lardo O, Hansell M.Alcoholic hepatitis: diagnosis and management.Am Fam Physician.2022;105(4):412-420
Peng Y, Qi X, Guo X.Child–Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Medicine (Baltimore).2016;95(8):e2877. doi:10.1097/MD.0000000000002877
Morgan TR.Treatment of alcoholic liver disease.Gastroenterol Hepatol (NY).2017;13(7):425–427.
Nusrat S, Khan MS, Fazili J, Madhoun MF.Cirrhosis and its complications: evidence based treatment.World J Gastroenterol.2014;20(18):5442–5460. doi:10.3748/wjg.v20.i18.5442
Phillips CA, Augustine P, Yerol PK, Rajesh S, Mahadevan P.Severe alcoholic hepatitis: current perspectives.Hepat Med.2019;11:97–108. doi:10.2147/HMER.S197933
Krishtopaytis E, Kumar P, Almomani A, et al..Smoking increases the risk for cirrhosis and esophageal varices among patients with non-alcoholic fatty liver disease.Am J Gastroenterol.2022;117(1OS):e907. doi:10.14309/01.ajg.0000861668.84072.e1
Goldberg D, Zarnegarnia Y.Prediction of long-term survival among patients with cirrhosis using time-varying models.Hepatol Commun.2023;7(6):e0185. doi:10.1097/HC9.0000000000000185
Kezer CA, Buryska SM, Ahn JC, Kamath PS, Shah VH, Simonetta DA.The mortality index for alcohol-associated hepatitis: a novel prognostic score.Mayo Clinic Proceedings.2022;97(3):P480-480. doi:10.1016/j.mayocp.2021.10.026
Casadaban LD, Parvinian A, Zivin SP, et al.MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort.Ann Hepatol.2015;14(3):380-388. doi:10.1016/S1665-2681(19)31278-5
McClain CJ, Rios CD, Condon S, Marsano LS.Malnutrition and alcohol-associated hepatitis.Clin Liver Dis.2021;25(3):557–570. doi:10.1016/j.cld.2021.03.002
Arab JP, Diaz LA, Baeza N, et al.Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: a worldwide study.J Hepatol.2021;75(5):1026-1033. doi:10.1016/j.jhep.2021.06.019
Im GY, Cameron AM, Lucey MR.Liver transplantation for alcoholic hepatitis.J Hepatol.2019;70(2):P328-334. doi:10.1016/j.jhep.2018.11.007
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