Alcohol-related liver disease

Chronic severe liver failure is fatal and although it can be treated by transplantation, there is a shortage of organs and transplantation is ineffective if you continue to drink heavily.

Alcohol-related liver disease is caused by drinking alcohol, usually over a sustained period of time, and one in five adults in the UK drink alcohol in a way that could harm their liver.^1,2

Regularly drinking more than the UK Chief Medical Officers' (CMOs) low risk drinking guidelines (no more than 14 units a week, with several drink free days) can harm your liver. The more you drink above the recommended limits, the higher your risk of developing alcohol-related liver disease. Some harm to the liver may occur in association with long-term consumption at much lower levels of drinking than the CMOs' low risk drinking guidelines.³

Are there other forms of liver disease?

Alcohol-related liver disease is distinguished from other forms of long-term liver disease such as non-alcohol related fatty liver disease and chronic  However, drinking alcohol is likely to make all of these conditions worse. Anyone who has any form of liver disease is advised not to drink alcohol or to seek advice from their specialist about their drinking.

Who does alcohol-related liver disease affect?

Although around seven in 10 people with alcohol-related liver disease have an alcohol dependence problem,⁴ it is not only daily drinkers who develop liver disease. Heavy drinking on a few days in the week is also associated with alcohol related liver disease.⁵

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By understanding the impact drinking alcohol  can have on your liver and reducing the amount you drink each week, some alcohol-related liver disease may be reversed, or further disease progression prevented.⁶

Increased alcohol intake can also give rise to obesity and diabetes. These co-morbidities, together with increased alcohol intake, have been associated with increased mortality from Covid 19.⁷

How does alcohol affect the liver?

Any time we drink alcohol, the liver must break it down prior to removal from the body. However, due to the toxicity of the products of alcohol's metabolism, some liver cells die during this process. Having a break from alcohol is important to allow the liver to recover and make new cells. Sustained heavy drinking doesn’t allow the liver time to do this.

This is thought to be why the liver is the organ that sustains the greatest degree of tissue damage through heavy drinking, which leads to alcohol-related liver disease.⁸

Find out if your drinking could be causing you harm

The stages of alcohol-related liver disease

Alcohol-related liver disease is a spectrum of disease that broadly consists of three stages, each increasing in severity. It also increases the risk of developing liver cancer.

1. Alcoholic fatty liver disease

‘Fatty liver’ develops because of a build-up of fat in the cells in the liver.⁹ And drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fat in the liver.¹⁰

It is estimated that alcohol-related fatty liver disease develops in 90% of people who drink more than 40g of alcohol (or four units) per day.¹¹ That’s roughly the equivalent of two medium (175ml) glasses of 12% ABV wine, or less than two pints of regular strength (4% ABV) beer.

This stage of alcohol-related liver disease does not usually cause any symptoms and may only be identified through a blood test. It’s also reversible by reducing your long-term alcohol consumption below the UK Chief Medical Officers’ (CMOs) low risk drinking guidelines. 

Your liver will start shedding excess fat if you stop drinking for at least two weeks¹² and - after that - ensure you do not exceed the CMOs’ low risk drinking guidelines. But if you don’t reduce your drinking at this stage, in up to a third of people with this condition, it will progress to the much more serious stages outlined below.

Find out more about the UK low risk drinking guidelines

2. Alcohol-related hepatitis

Alcohol-related hepatitis is a potentially serious condition caused by heavy alcohol consumption over a longer period. Between 10–35% of individuals with alcohol-related fatty liver disease who continue drinking heavily will develop alcohol-related hepatitis.¹³

While alcohol-related hepatitis usually occurs after years of harmful drinking, it can also occur if you drink a large amount of alcohol in a shorter period of time.¹⁴

As with fatty liver disease, alcohol-related hepatitis may be reversed if you stop drinking. However, continuing to drink any amount of alcohol when you have alcohol-related hepatitis will increase the risk of developing cirrhosis.

3. Cirrhosis

Cirrhosis of the liver has several causes, one of which is alcohol. The third stage of alcohol-related liver disease is cirrhosis – where healthy liver tissue has been replaced permanently by scar tissue. This is the result of long-term, continuous damage to the liver.

Up to one in every five long-term heavy drinkers will develop alcohol-related liver cirrhosis.¹⁵ While cirrhosis is not reversible, there is good evidence that stopping drinking completely improves the outcome for some people.¹⁶

If you have cirrhosis and do not stop drinking, then you are likely to die from liver failure. 5,840 people in the UK died of alcohol-related liver disease in 2019.¹⁷  There is always a shortage of donor organs and people who are not abstinent cannot usually access liver transplants in the UK.

Liver cancer

Alcohol-related cirrhosis increases the risk of developing liver cancer.^18,19 Of people with liver cirrhosis, every year almost three out of every 100 (2.9%) of them will develop alcohol-related liver cancer.²⁰

Find out more about liver cancer and alcohol.

Identifying alcohol-related liver disease: the symptoms

The early stages of alcohol-related liver disease can be difficult to identify as there are not usually any symptoms. Often this means alcohol-related liver disease is diagnosed during tests for other conditions, or at a stage of advanced liver damage.

Symptoms may include:²¹

• Abdominal (tummy) pain 
• Loss of appetite
• Diarrhoea
• Fatigue
• Nausea
• Vomiting

Later stage liver damage symptoms, which are more serious and easier to identify, include:²²

• Bleeding in the gut
• Easy bruising
• Fatigue
• Jaundice (yellow skin)
• Increased sensitivity to alcohol and drugs, both medical and recreational (because the liver cannot process them)
• Itching
• Swelling of the legs, ankles, or abdomen
• Vomiting blood
• Weakness, loss of appetite

Stopping or reducing your drinking

Drinking within the UK Chief Medical Officers' (CMO) low risk drinking guidelines (drinking no more than 14 units a week for both men and women) will help keep your risk of developing alcohol-related liver disease low and benefit your overall health.

Reducing the amount you drink, ideally to zero, can help reverse damage, and reduce the risk of disease progression, for those with early-stage alcohol-related liver disease.

How to stop drinking alcohol completely

If you have established alcohol-related liver disease, it is essential that you stop drinking completely and permanently, to help prevent progression to even more serious disease. You will probably need professional help to stop drinking:

• England
• Northern Ireland
• Scotland
• Wales

Further information

Your GP or a member of their team can help you figure out if you should make any changes in your drinking, and offer help and advice along the way.

If you’re concerned about someone’s drinking, or your own, Drinkline runs a free, confidential helpline. Call 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm).

The British Liver Trust provides support and information on liver disease. Call their free helpline Monday to Friday from 10am to 3pm on 0800 652 7330 or visit the British Liver Trust website.