Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.
ARLD doesn’t usually cause any symptoms until the liver has been severely damaged. When this happens, 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
This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.
If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.
Read more about:
symptoms of ARLD
diagnosing ARLD
In many cases, people with alcohol-related liver disease (ARLD) don’t have any noticeable symptoms until their liver is badly damaged.
If you do experience early symptoms of ARLD, these are often quite vague, such as:
abdominal pain
loss of appetite
fatigue
feeling sick
diarrhoea
feeling generally unwell
As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as:
yellowing of the skin and whites of the eyes (jaundice)
swelling in the legs, ankles and feet, due to a build-up of fluid (oedema)
swelling in your abdomen, due to a build-up of fluid known as ascites
a high temperature (fever) and shivering attacks
very itchy skin
hair loss
unusually curved fingertips and nails (clubbed fingers)
blotchy red palms
significant weight loss
weakness and muscle wasting
confusion and memory problems, trouble sleeping (insomnia) and changes in your personality due to a build-up of toxins in the brain
vomiting blood and black, tarry stools due to internal bleeding
a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums
increased sensitivity to alcohol and drugs (because the liver can’t process them)
If you’re abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3 to 7 days from the time of your last drink.
Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases their sleep pattern returns to normal within a month.
In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offered a medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process.
Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, so their progress can be closely monitored.
If you’re staying at home, you’ll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service.
The use of medication to directly treat ARLD is controversial. Many experts have argued there’s limited evidence for its effectiveness.
For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids or pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition.
Nutritional support is also an important part of treatment in these cases.
Other medications that have been used to treat liver damage include:
anabolic steroids (a more powerful type of steroid medication)
ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands)
However, there’s a lack of good evidence that these help and they’re no longer used for severe alcoholic hepatitis.