DEAR MAYO CLINIC: My father has been diagnosed with alcoholic hepatitis. Is there any treatment for him? What kind of doctor should he see?
ANSWER: First and foremost, it's critical that your father stop drinking. Alcoholic hepatitis, an acute inflammation of the liver, is a life-threatening illness with limited treatment options.
With abstinence, further liver damage may be prevented. In some cases, the damage from alcoholic hepatitis can be reversed when patients stop drinking. When patients continue drinking, the disease can progress to cirrhosis, an irreversible scarring of the liver, and eventually, liver failure.
Alcoholic hepatitis is caused by injury and inflammation that occurs in the liver in response to prolonged and excess alcohol consumption. In men, more than four to eight drinks per day is considered a risk factor for developing alcoholic hepatitis. In women, it's greater than three to five drinks daily. From 10 to 35 percent of alcohol abusers develop the disease. As yet undefined genetic factors seem to increase the risk of alcoholic hepatitis.
Alcoholic hepatitis is more common in men, but women develop more severe forms of the disease, even while consuming less alcohol. A possible reason is that when women and men drink the same amount of alcohol, women show a higher blood alcohol content. This holds true even when weight differences are taken into account.
It's good your father knows what he's dealing with so he can take steps to stop the disease. Some people have no symptoms of early alcoholic hepatitis. For others, symptoms are general and include nausea, vomiting, weight loss, weakness, pain, fever, jaundice and diarrhea. A scoring system that helps diagnose alcohol-related liver disease from more benign concerns is available online at http://www.mayoclinic.org/gi-rst/mayomodel10.html.
Treatment depends somewhat on the stage of the illness. Results from blood and urine tests and other factors can help a doctor determine the severity of the disease using one of several assessment tools. Mayo Clinic researchers have developed some mathematical models for determining disease severity (http://www.mayoclinic.org/gi-rst/models.html).
Regardless of the illness stage, abstinence and other lifestyle changes are the first line of treatment. If your father is a smoker, quitting may help slow the progression of liver disease. Good nutrition is especially important. Many people with advanced alcoholic hepatitis are malnourished because they don't eat well, and the body's ability to absorb nutrients is impaired by the disease. A diet with adequate protein, supplemented by vitamins B, C, K and folic acid, can help.
Medications sometimes are used to treat alcoholic hepatitis, but there's little consensus on their effectiveness. Some options include:
- Corticosteroids. These drugs are the most-researched medication treatment for alcoholic hepatitis; study results are inconsistent. Results suggest that corticosteroids may improve survival in patients with severe hepatitis and hepatic encephalopathy, a brain damage syndrome due to alcoholic hepatitis.
- Pentoxifylline. This drug, which improves blood flow by decreasing blood viscosity, has been shown to improve short-term survival in patients with alcoholic hepatitis.
- Anti-TNF-alpha therapy. TNF-alpha is a protein that acts as an inflammatory agent. It's very active in patients with alcoholic hepatitis and is associated with a poor prognosis. Anti-TNF-alpha therapy was believed to be a promising approach to stem alcoholic hepatitis. However, studies to date haven't shown a benefit.
Liver transplant is an option for people with end-stage alcoholic liver disease. But due in part to a shortage of donated livers, only 6 percent of those with end-stage disease receive transplants. Many transplant centers require six months of alcohol abstinence before transplant is considered. Some patients improve while abstaining—so no transplant is needed. For those who have transplants, the seven-year survival rate is about 60 percent.
A hepatologist—a specialist in liver disease—is the best choice to care for your father. If seeing a hepatologist isn't convenient, a gastroenterologist or internal medicine specialist with experience in liver disease is a good option.—Vijay Shah, M.D., Hepatology, Mayo Clinic, Rochester, Minnesota
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. To submit a question, write to: firstname.lastname@example.org, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.)