Liver is the second largest human organ. It removes toxins in your body, controls cholesterol levels, fight infections, aids digestion among other key functions. Sadly, liver diseases don’t show any signs or symptoms until it reaches an advanced stage.

Magnitude of Problem

• ? Alcohol related toxicity is the third most common cause of morbidity and the fifth most common cause of disease burden worldwide.
• ? It is the leading cause of mortality in people aged 15-49 years, and the total expenditure amounts to billions of dollars.
• ? WHO estimates that 140 million people worldwide suffer from alcohol dependency, causing damage to lives and economies.
• ? The National Institute on Alcohol Abuse and Alcoholism recommends that both males and females should not drink more than 28 g and 14 g per day, respectively.
• ? In addition, steady daily drinking, as compared with binge drinking, appears to be more harmful
• ? Persistent and heavy for long period more risky than sporadic heavy drinking.
• ? In USA, 2nd leading cause for liver transplantation is alcoholic cirrhosis.
• ? In India alcoholic liver disease occurs a decade early compared to west.
• ? Women had greater susceptibility to ALD at any given level of intake.

What is the spectrum of alcohol related liver disease?

There are three main types: alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis.

Alcoholic cirrhosis leads to complications of ascites, blood in vomitus, liver cancer at advanced stage.

Alcohol related fatty liver

Excess alcohol consumption leads to accumulation of excess fat in the liver in 90% of individuals. This is the earliest stage of alcohol-related liver disease and usually there are no symptoms. Although reversible, cirrhosis may develop in 10% of heavy drinkers.

Patients who drink alcohol and are overweight or have diabetes have a higher risk of progressive liver damage.

Alcoholic hepatitis

In Alcoholic hepatitis, there is inflammation and swelling of the liver. It develops in individuals who are heavy drinkers and those who indulge in binge drinking. Symptoms include loss of appetite, nausea, vomiting, abdominal pain, fever and jaundice. One out of three heavy drinkers develops alcoholic hepatitis. If it is mild, liver damage may be reversed after stopping alcohol. Some patients of mild alcoholic hepatitis continue to drink alcohol, and they may quickly progress to severe alcoholic hepatitis and develop liver failure. Signs of liver failure are accumulation of fluid in the belly, swelling of feet and mental confusion. Severe alcoholic hepatitis is a very serious condition and fifty percent of patients with severe alcoholic hepatitis die within one month.

Alcoholic cirrhosis

Alcoholic cirrhosis is scarring of the liver — hard scar tissue replaces soft healthy tissue. It is the most serious type of alcohol-related liver disease. Between 10 and 20 percent of heavy drinkers develop cirrhosis. The damage from cirrhosis cannot be reversed and usually leads to development of ascites, mental confusion, and blood in vomitus or passage of blood in stools, frequent infections and ICU admissions.

In one of the studies done by me in Liver ICU, consisting of 522 cirrhotic patients, majority (>50 per cent) had alcohol related liver disease. The prognosis of these patients was very poor with dismal survival. The cost involved in care of such patients may go upto 1 lakh rupees per day due to multiple organ failure state.

Most of these patients require liver transplantation after a period of alcohol abstinence.