Alcohol-Related Liver Disease

ARLD doesn’t usually cause any symptoms until the liver has been severely damaged. This means ARLD is often diagnosed coincidentally during tests for other conditions.

As ARLD progresses symptoms can include:

• feeling sick
• weight loss
• loss of appetite
• yellowing of the eyes and skin (jaundice)
• swelling in the ankles and tummy
• confusion or drowsiness
• vomiting blood or passing blood in your stools
• internal (variceal) bleeding
• build-up of toxins in the brain (encephalopathy)
• fluid accumulation in the abdomen (ascites) with associated kidney failure
• liver cancer
• increased vulnerability to infection

Life-threatening complications of ARLD include:

Read more about the complications of ARLD.

As its name implies, ARLD is solely caused by the consumption of alcohol.

The liver is the largest internal organ in the human body and apart from the brain it is the most complex, performing over 500 different functions.

These functions include:

• filtering toxins from the blood
• aiding digestion of food
• regulating blood sugar and cholesterol levels
• helping fight infection and disease

The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.

ARLD is very common in the UK. The number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse.

Read more about the causes of ARLD.

Stages of ARLD

There are 3 main stages of ARLD, although there’s often an overlap between each stage. These stages are explained below.

Stage 1: Alcoholic fatty liver disease

Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease and is the first stage of ARLD.

Fatty liver disease rarely causes any symptoms, but it’s an important warning sign that you’re drinking at a harmful level.

In the early stage, fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your liver can return to normal.

Stage 2: Alcoholic hepatitis

Alcoholic hepatitis, which is unrelated to infectious hepatitis, is a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware they’re damaging their liver through alcohol.

Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (“binge drinking”)

The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.

Severe alcoholic hepatitis, however, is a serious and life-threatening illness.

Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage.

Stage 3: Cirrhosis

Cirrhosis is a stage of ARLD where the liver has become significantly scarred (“fibrotic”). This means that the normal functioning liver tissue is replaced by non-functioning scar tissue. Even at this stage, there may not be any obvious symptoms but as cirrhosis progresses the liver reaches a tipping point beyond which there is no longer sufficient functioning liver tissue to perform all the complex tasks the body requires it to. Beyond this point the liver begins to fail (“decompensate”) and the body begins to develop significant symptoms and signs of the disease.

Cirrhosis is irreversible but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.

About one in 10 people who drink harmful amounts will develop cirrhosis.

A person who has alcohol-related cirrhosis and does not stop drinking has a less than 50% chance of living beyond 5 more years.

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is because the condition causes few obvious symptoms in the early stages.

If a doctor suspects ARLD, they’ll usually arrange a blood test to check how well your liver is working. However, liver function tests can be normal at many stages of liver disease. Your doctor may also ask about your alcohol consumption.

If your symptoms or liver function test suggest an advanced form of ARLD (either alcoholic hepatitis or cirrhosis), you may need further tests.

These might include liver imaging (by ultrasound scan, CT scan or MRI) or a Fibroscan which can detect the presence of scarring in the liver by measuring its stiffness.

Further investigations under specialist management might include liver biopsy (during which a fine needle is inserted into the liver and a small piece of tissue is taken for examination under a microscope) and/or endoscopy (in which a flexible camera is passed through the throat to inspect the gullet and stomach). A liver biopsy can give an accurate assessment of liver scarring, whilst endoscopy looks for any signs of swollen veins in the gullet (oesophageal varices) or inflammation of the stomach (gastritis) both of which can lead to significant gastrointestinal bleeding.

It’s important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need.

Since ARLD is the result of excessive alcohol consumption, the mainstay of treatment involves reducing or stopping the consumption of alcohol.

If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2 weeks. After this it may be safe to start drinking again if you stick to the NHS guidelines on alcohol consumption.

If you have a more serious form of ARLD (alcoholic hepatitis or cirrhosis) then lifelong abstinence from alcohol consumption is recommended.

This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease.

The success of treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle.

If you have alcohol-related cirrhosis or alcoholic hepatitis and don’t stop drinking, no medical or surgical treatment can prevent liver failure.

Malnutrition is common in people with ARLD, so it’s important to eat a balanced diet to make sure you get all the nutrients you need.

Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and tummy caused by a build-up of fluid.

Get tips for a lower salt diet

In cases of established liver failure resulting from cirrhosis medications may be helpful in controlling symptoms and preventing further complications. These might include water tablets (diuretics), vitamin supplements and antacids.

The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits:

• men and women are advised not to regularly drink more than 14 units a week
• spread your drinking over 3 days or more if you drink as much as 14 units a week
• Focus on a healthy balanced diet that includes lots of fresh vegetables, fruit, wholegrain carbohydrates and lean protein, such as chicken. Cut down on processed foods and snacks that are high in fat and sugar.
• Aim to reduce your weight (if necessary) so that you have a BMI of 18.5-24.9. This is in the healthy range. As well as drinking too much alcohol, another common cause of fatty liver is being overweight or obese – losing 10% of your bodyweight can reduce the amount of fat in the liver and help prevent inflammation.
• Make exercise a regular part of your daily routine. Aim for 150 minutes per week (30 mins five days a week, for example) of moderate-to-intense activity every week, such as running, cycling or brisk walking.
• you feel you should cut down on your drinking
• other people have been criticising your drinking
• you feel guilty or bad about your drinking
• you need a drink first thing in the morning to steady your nerves or get rid of a hangover
• they regularly drink more than 14 units of alcohol a week
• they’re sometimes unable to remember what happened the night before because of their drinking
• they fail to do what was expected of them as a result of their drinking (for example, missing an appointment or work because they’re drunk or hungover)
• hand tremors – “the shakes”
• sweating
• seeing things that are not real (visual hallucinations)
• depression
• anxiety
• difficulty sleeping (insomnia)

A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.

Even if you have been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health.

If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.

The following lifestyle changes will also help to improve your overall health, as well as the health of your liver. Malnutrition (lack of nutrients the body needs to stay healthy) is common in people with this type of liver disease, so a healthy diet is particularly important.

Am I drinking too much alcohol?

You could be misusing alcohol if:

Someone you know may be misusing alcohol if:

If you want to cut down, a great way is to spread your drinking out over the days a week. Test out having a break for yourself and see what positive results you notice.

If someone loses control over their drinking and has an excessive desire to drink, it’s known as dependent drinking (alcoholism).

Dependent drinking usually affects a person’s quality of life and relationships, but they may not always find it easy to see or accept this.

Severely dependent drinkers are often able to tolerate very high levels of alcohol in amounts that would dangerously affect or even kill some people.

A dependent drinker usually experiences physical and psychological withdrawal symptoms if they suddenly cut down or stop drinking, including:

This often leads to “relief drinking” to avoid withdrawal symptoms.

For more information about alcohol misuse click here

To download the British Liver Trust’s free .pdf booklet “Alcohol and liver disease” click here

Your alcohol intake may be assessed using tests, such as:

• Alcohol use disorders identification test (PDF, 224kb) – a widely used screening test that can help determine whether you need to change your drinking habits
• Alcohol use disorders identification test consumption (PDF, 382kb) – a simpler test to check whether your drinking has reached dangerous levels

For details of NHS support for people with alcohol problems click here

As well as the NHS, there are several charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem. For example, you may want to contact:

• Drinkline – a national alcohol helpline on 0300 123 1110
• Alcohol Change UK
• Alcoholics Anonymous helpline on 0800 9177 650
• Al-Anon Family Groups helpline on 020 7403 0888
• Smart Recovery – a charity that promotes addiction recovery
• drinkaware – a charity to help change your relationship with alcohol
• We are with you (formerly Addaction) – providing free, confidential support with alcohol, drugs or mental Health issues

Local services within Devon & Cornwall:

• Together Drug & Alcohol Service Devon – Exeter, Mid-Devon & North Devon
• Torbay Drug & Alcohol Service – Torbay
• Harbour Drug & Alcohol Services – Plymouth
• Y-SMART – substance & alcohol misuse support for young people under 18 across Devon (excluding Plymouth & Torbay)
• Safer Devon – preventing and tackling hidden and visible harm in Devon including problem drinking and problem drug use
• Safer Cornwall – incorporating We-are-with-you (formerly Addaction) to provide drug & alcohol support across Cornwall and the Isles of Scilly

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting Times
• Local Support – Find services near me