People typically consume alcohol by drinking beer, wine and distilled spirits like vodka, and whiskey. The ethanol content of beer is about 5% while it ranges between 8% – 15% for wine, and 20% – 40% for distilled spirits. The definition of heavy alcohol drinking is consuming 15 or more for men, and eight drinks or more per week for women. However, if you already have chronic liver disease, even small amounts of alcohol can worsen your liver condition. Is alcohol good for your health? Not really. Recent studies really suggest that the initial research on the benefits of alcohol were overplayed.Excessive consumption of alcohol may lead to numerous problems, i.e. increased risk of road traffic injuries, nutritional deficiencies, liver disease, and cancer. Today, let me talk about effect of alcohol to our liver.
British Liver Trust1 had mentioned that Liver disease is the third leading cause of premature death in the UK, and Alcohol-related liver disease (ARLD) accounts for 60% of all liver disease. How about the situation of ARLD in Malaysia? According to Statista2, around 411 people in Malaysia had died due to liver cirrhosis caused by alcohol consumption in 2016. A recent local literature had studied the aetiologies of liver cirrhosis among patients attending a tertiary hospital at Selangor – alcoholic was the 4th commonest aetiology (11.8%), and it was the major cause of cirrhosis among Indian patients.3
In general, we divide alcohol related liver disease (ARLD) into 3 types:
Alcoholic fatty liver disease – excessive fat accumulation inside liver cells, which makes it harder for the liver to function. One should be suspected of alcoholic fatty liver disease if he/she has alcohol drinking habit with radiological evidence of fatty liver. The condition will usually go away if one stops drinking.
Acute alcoholic hepatitis – inflammation, or swelling, of the liver accompanied by the destruction of liver cells. At this stage, we can observe the elevation of liver enzymes from the blood test.
Liver cirrhosis – the most serious type of ARLD. It refers to the replacement of normal liver tissue with scar tissue. This is mainly diagnosed from the ultrasound or CT scan, which liver biopsy is rarely indicated nowadays. About 10% – 20 % of heavy drinkers will develop cirrhosis after 10 or more years of drinking. Cirrhotic patients have higher risk to develop to liver cancer.
Many patients with ARLD do not usually show any symptom until the liver has been severely damaged. One may present with tiredness, poor appetite, unexplained weight loss, yellowing of the eyes and skin (or jaundice), swelling of ankles or legs, and/or abdominal bloateness. At the advanced stage of ARLD-cirrhosis, a patient may present with confusion or coma, vomiting blood or passing blood in the stool. Excessive or prolonged alcohol drinking is also thought to increase risk of developing acute/chronic pancreatitis.
At clinic, we can suspect a patient may have ARLD based on a his/her history of alcohol drinking, laboratory or radiologic abnormalities or medical conditions related to alcohol abuse. Further blood tests may be ordered to rule out other liver diseases. Occasionally, we may need to do a liver biopsy.
People with ARLD should stop drinking completely. Proper counselling, medications, detoxification (or detox) program or a residential inpatient stay can be helpful. Vitamin and nutritional supplements may be required to improve the nutrition status.
References:
- British Liver Trust. https://britishlivertrust.org.uk/about-us/media-centre/statistics
- Malaysia: number of alcohol deaths by cause 2016. https://www.statista.com.
- JY Chieng, Yan, P., Fong, L., Muhammad, M., & Said Abu Hass, S. A. T. (2022). Aetiologies of Liver Cirrhosis among Adult Patients attending a Hepatology Clinic at Selangor, Malaysia. International Journal of Public Health Research, 12(1).