GG, a 60-year old man, was noticed to have yellowness of his eyes. He had otherwise been fine. He consulted his physician for comprehensive evaluation. Only years of heavy alcohol intake was found significant in his history. Among other recommendations, he was counselled to stop taking alcohol.
Alcoholic liver disease (ALD) is a spectrum of diseases affecting the liver which results from alcohol over-consumption. The disease occurs following years of heavy drinking which may be daily, a few days a week, or on weekends. The chances of developing ALD increases with the amount of alcohol consumed and the duration the person has been drinking.
Alcohol abuse is common worldwide. 18 out of 100 adults in the USA indulge in excessive alcohol ingestion. Rates of alcoholic liver disease are higher in areas with greater alcohol consumption compared with areas with low levels of consumption. It is important to note that one doesn’t have to get drunk for alcoholic liver disease to develop.
What type of alcohol causes Alcoholic Liver Disease? Any type of alcohol can cause alcoholic liver disease. Women are more likely to have ALD when compared to men, and it seems to occur more in certain families.
Men who drink ≥30 grams/day (approx. 70cl of average 5.5% beer); and women who drink ≥20grams/day (approx. 46cl of average 5.5% beer); are at increased risk of cirrhosis (a type of alcoholic liver disease). However, most patients will not develop cirrhosis despite heavy alcohol intake; but nobody can tell who will or will not develop the disease. Unfortunately, among those who do develop the liver disease, symptoms often develop only after severe, life-threatening liver disease had already developed.
How does Alcoholic Liver Disease manifest? The manifestations of ALD depend on the type and severity of the disease.
- Some persons may not have any complaint but routine abdominal scan will reveal that the disease is present.
- Some will have jaundice (yellowness of the white part of the eyes, skin, etc). Their blood test will show abnormal and elevated liver enzymes.
- Some individuals may have redness of the palms, abnormally enlarged breasts in men, parotid gland fullness, and abnormal fluid accumulation in the abdomen.
- Some may bleed into the gastrointestinal tract thereby vomiting blood or pass black and tarry stools.
- Sleep disturbances, confusion, and possibly coma; suggesting that the liver disease is affecting the brain; may be present.
- Individuals with ALD often have other organ problems such as heart disease, pancreatic dysfunction, nerve disorders and muscle wasting.
- They also have nutritional deficiencies from low levels of vitamins in the body.
What investigations are necessary in the care of individuals with ALD? Investigations carried out aim to diagnose the disease and establish the severity of the disease. They also screen for other associated diseases. These investigations include blood tests, abdominal scans, and possibly liver biopsies (insertion of a needle through the abdomen to take a sample of the liver).
What treatment options are there for Alcoholic Liver Disease? The treatment includes
- Discontinuation of alcohol ingestion- regardless of the stage.
- Replacement of vitamin deficiencies.
- Treatment of complications, if any.
Opeyemi O. Owoseni is a Gastroenterologist and Hepatologist. She is a Fellow of the Medical College of Physicians, Nigeria. She is a member of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) and that of the American Society for Gastrointestinal Endoscopy (ASGE). She currently consults for several hospitals and performs liver biopsies, fibroscans, diagnostic and therapeutic endoscopies. She can be reached on firstname.lastname@example.org