Who Is Susceptible to Alcoholic Hepatitis?
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As the second of the three stages of alcoholic liver disease, alcoholic hepatitis is striking a growing number of people worldwide. With potentially fatal consequences, being able to recognize what predisposes someone to develop this disease may help prompt its early discovery and appropriate action. Since alcohol is the culprit of liver inflammation in alcoholic hepatitis, it may be reversible through abstinence when detected early enough. Unfortunately, when chronic hepatitis is caused by a virus, it is much harder to turn around.
The 3 Stages
There are three primary stages of alcoholic liver disease, although the progression through each stage can vary. Only through a liver biopsy (or comparable method) can the degree of liver damage be evaluated.
- Stage 1 – In the first stage of alcoholic liver disease, the person develops a fatty liver where there is minimal change to liver tissue. While a fatty liver is not linked to deterioration in liver function, abnormalities may be seen in some of the liver function tests. Even though fatty liver is reversible with alcohol abstinence, it is also the first step in progressing toward cirrhosis.
- Stage 2 – As fatty liver worsens, the liver becomes inflamed. Alcoholic hepatitis is the liver inflammation that ensues during the second step in alcoholic liver disease. Alcoholic hepatitis can range from mild to life-threatening, and may be present with or without liver inflammation symptoms. Similar to a fatty liver, abstinence from alcohol can reverse the effects of alcoholic hepatitis, but those who continue to drink heavily have a high risk of developing cirrhosis.
- Stage 3 – The final, irreversible stage of alcoholic liver disease is cirrhosis. Characterized by scarring and nodules on the liver, cirrhosis severely inhibits liver function, reduces life expectancy and increases the likelihood of developing liver cancer or liver failure.
If caught early on, fatty liver or mild alcoholic hepatitis can be mitigated by abstaining from drinking alcohol. However, advanced cases of alcoholic liver disease – whether severe alcoholic hepatitis or cirrhosis – renders the remaining liver capacity insufficient for carrying out normal, body functions.
Susceptibility
The relationship between drinking alcohol and developing alcoholic hepatitis is not necessarily linear. Only a small percentage of heavy drinkers develop alcoholic hepatitis, yet the disease can occur in people who drink only moderately or binge just once.
While the liver damage from alcoholic hepatitis has the potential to be reversed in people who stop drinking, this dangerous disease is likely to progress to cirrhosis and liver failure in those continuing to indulge. Because many people who drink heavily or binge drink never develop alcoholic liver disease, it’s likely that factors other than alcohol play a role:
- Genetic factors – Genetic mutations affecting alcohol metabolism may increase the risk of alcoholic liver disease as well as of alcohol-associated cancers. Genetic factors may account for half of any person’s susceptibility to alcohol-related disease.
- Other types of hepatitis – Long-term alcohol abuse worsens the liver damage caused by other types of hepatitis, especially Hepatitis C. If you have Hepatitis C and also drink (even moderately), the likelihood of developing cirrhosis is much greater than in someone who doesn’t drink.
- Other diseases – People who drink alcohol are more likely to develop alcoholic hepatitis if they also have another disease affecting the liver, such as diabetes or hemochromatosis.
- Obesity – Although most researchers agree that obesity makes alcoholic liver disease worse, the reasons are unclear. A likely cause is that alcohol causes fatty tissue to produce certain hormones and cytokines responsible for increasing inflammation throughout the body.
- Malnutrition – For one or both of the following reasons, many people who drink heavily are malnourished:
- Because alcohol is often substituted for food, nutritional habits may be poor.
- Because alcohol and its toxic byproducts prevent the body from properly absorbing and metabolizing nutrients, substances such as protein, vitamins and essential fats never make it to the body’s blood circulation.
In both cases, the lack of absorbed and metabolized nutrients contributes to liver cell damage. While it was previously thought that malnutrition – rather than alcohol – caused alcoholic liver disease, the relationship between the two appears more complicated.
- Alcohol use – Consistent heavy drinking or binge drinking is the primary risk factor for alcoholic hepatitis, though it’s hard to precisely define heavy drinking. Some experts believe that four or more drinks a day for men and two or more a day for women greatly increase the risk of liver damage. Moderate drinking is usually defined as no more than two drinks a day for men and one for women. However, because people vary greatly in their sensitivity to alcohol, these amounts can vary dramatically.
- Age – The effects of alcoholic hepatitis are likely cumulative, showing up after years of heavy drinking. However, symptoms of this disease can develop in people as young as 20.
- Gender – Women are two to three times as likely to develop alcoholic liver disease as men are. Experts believe this inequality is because it takes less alcohol to harm the liver in women, and liver disease progresses more quickly in women than in men. This disparity may result from genetic differences in the way alcohol is absorbed and broken down. Because women tend to metabolize alcohol more slowly, their livers are exposed to higher blood concentrations of alcohol for longer periods of time – with potentially greater toxicity. The slow rate of alcohol metabolism in women may be due to:
- lower levels of stomach enzymes to break down alcohol
- the effects of the female hormone estrogen
- the typically smaller size of a woman’s liver
According to medical experts, even an occasional drinker is susceptible to developing alcoholic hepatitis. Since so many factors can contribute to the development of alcoholic liver disease, there is only one way to eliminate this threat. Making the monumental effort to quit drinking alcohol can return a liver to its pre-alcohol, healthy state. As long as abstinence occurs before the last stage of alcoholic liver disease begins, there is great hope for eradicating the perils of alcoholic hepatitis.
References:
Lederer, Sharon L., et al, Distinct cellular responses differentiating alcohol- and hepatitis C virus-induced liver cirrhosis, Virology Journal, November 2006.
www.gastroresource.com, Alcoholic Liver Disease, F. Wong, L. Blendis, First Principles of Gastroenterology, AstraZeneca Canada Inc., 2000.
www.hepatitis.org, Acute Alcoholic Hepatitis, Dr. Langlet Philippe, hepatitis.org, 2007.
www.mayoclinic.com, Alcoholic Hepatitis, Mayo Foundation for Medical Education and Research, 2007.
www.montana.edu, Alcohol and Liver Disease, Montana State University, 2007.
www.netdoctor.co.uk, Alcoholic Liver Disease, Dr. Matthew Warren, Professor Christopher P. Day, Netdoctor.co.uk, 2007.
