Medicines for Alcohol-related liver disease

What it is

Alcohol-related liver disease (ARLD) is damage to the liver caused by drinking too much alcohol over a long period. The liver processes alcohol, and drinking more than it can safely handle, over months and years, can progressively damage it. ARLD is common and an important cause of liver disease, but much of it is preventable, and — crucially — in its earlier stages the liver has a remarkable ability to recover if alcohol is stopped. ARLD develops through stages: fatty liver (a build-up of fat in the liver, which is common with heavy drinking, usually causes no symptoms, and can reverse if drinking stops); alcoholic hepatitis (inflammation of the liver, which can range from mild to severe and life-threatening); and cirrhosis (severe scarring of the liver, which is largely irreversible and can lead to liver failure and other serious complications). A key and challenging feature of ARLD is that it often causes no symptoms until it is advanced, so significant liver damage can be present without a person feeling unwell. When symptoms do occur, particularly in more advanced disease, they can include: tiredness; feeling generally unwell; loss of appetite and weight loss; feeling or being sick; tummy pain or swelling; yellowing of the eyes and skin (jaundice); swelling of the legs or tummy (fluid build-up); easy bruising or bleeding; itchy skin; and confusion. The most important treatment, at any stage, is to stop drinking alcohol — this can allow the liver to recover in the earlier stages and prevent further damage and complications in later stages. Support to stop or reduce drinking is available and is central to treatment, along with managing any complications and looking after general health. Because ARLD is often silent, and because reducing or stopping alcohol makes such a difference, the key messages are that ARLD is caused by drinking too much alcohol over time, that it is often silent until advanced, that stopping drinking can allow recovery in earlier stages and prevent progression, and that support to reduce or stop drinking is available and effective.

How it is treated

The management of alcohol-related liver disease centres on stopping alcohol — the single most important step at any stage — along with support to do so, managing any complications, and looking after general health. The most important treatment is to stop drinking alcohol: in the earlier stages (such as fatty liver, and often milder alcoholic hepatitis), stopping alcohol can allow the liver to recover and reverse some of the damage; and in more advanced disease (such as cirrhosis), stopping alcohol prevents further damage, reduces the risk of complications, and improves the outlook, even though the existing scarring cannot be reversed. Because stopping or reducing drinking can be difficult, support is a central part of treatment and is effective — this can include advice and support from a GP or specialist alcohol services, counselling and psychological support, medicines that can help some people stop or stay off alcohol, and support for withdrawal where needed (stopping suddenly after heavy, dependent drinking can be dangerous and should be done with medical support). Alongside this, care includes: managing any complications of liver disease (for example fluid build-up, bleeding risks, confusion, or infections, in more advanced disease); good nutrition (as people with ARLD are often malnourished); vaccinations and general liver care; and monitoring the liver. For severe alcoholic hepatitis or advanced cirrhosis, specialist care is needed, and in carefully selected cases of end-stage liver disease, liver transplantation may be considered (usually requiring a period of abstinence). Because ARLD is often silent until advanced, people who drink heavily may be assessed for liver damage, and reducing drinking is beneficial at any point. The reassuring and empowering messages are that stopping drinking is the key treatment and can allow the liver to recover in earlier stages and prevent progression in later stages, that support to stop or reduce drinking is available and effective, and that it is never too late to benefit from cutting down or stopping — so anyone concerned about their drinking or liver health is encouraged to seek help.