An overview of alcoholic hepatitis, explained by an expert

Written by: Professor Shahid Khan
Edited by: Cameron Gibson-Watt

Alcoholic hepatitis is an inflammatory liver condition that can affect people who are heavy drinkers. If left undiagnosed, it can lead to serious liver complications and be life-threatening.

Professor Shahid A Khan is a leading consultant physician based in London who specialises in managing patients with liver disease, including those diagnosed with alcoholic hepatitis. In his latest article, he provides us with a short overview of the condition, what causes it and what to expect if you have received a diagnosis.



What is alcoholic hepatitis?

Alcoholic hepatitis is an injury to the liver caused by drinking too much alcohol over an extended period. The condition causes inflammation and is potentially very serious. In severe cases, the liver can be so badly damaged that it can lead to liver failure and be fatal.


How common is alcoholic hepatitis?

Not everyone who drinks heavily will get alcoholic hepatitis. Around 15-30% of excessive drinkers are at risk of developing this condition. But, there are additional risk factors that mean you are more likely to develop it if you excessively drink and fall into one or more of these categories:


  • Gender - women are at a higher risk of developing alcoholic hepatitis. It may be due to the differences in how men’s and women’s bodies break down alcohol.
  • Obesity - people that are overweight are more likely to develop the condition.
  • Ethnicity - BME people are believed to be at a higher risk.
  • Binge drinking - frequently having several drinks within a few hours increases your risk.
  • Genetic factors - certain genetic factors suggest that some people process alcohol differently making them more susceptible, but this is still being researched.


Alcohol hepatitis can occur at any age. I have seen it develop in people in their 20s right up to their 70s. It all comes down to how long the person has been drinking.


The majority of patients we see, however, are generally between 40-60 years old. Remember though this does not mean that people outside that age group can drink as much as they want! It’s very important to be cautious of your drinking habits to avoid alcohol-related health problems occurring now and later in life. Alcohol-related liver disease is not an uncommon cause of death in people aged 40-60 years.


How much alcohol does it take to develop alcoholic hepatitis?

It’s hard to say exactly how much alcohol is too much as not every heavy drinker will go on to develop alcoholic hepatitis. The current UK guidelines say to limit your alcohol intake to 14 units a week for both women and men. This is the equivalent of no more than six pints of regular-strength beer or seven average-sized glasses of wine per week. At least two days per week without any alcohol is also generally recommended.


What are the symptoms of alcoholic hepatitis?

The symptoms of alcohol hepatitis range, depending on the severity of the condition. If you have it mildly, you may not notice any symptoms. However, as more damage occurs, you could start to notice:


  • Nausea
  • Vomiting
  • Abdominal discomfort or pain
  • Fever
  • Fatigue
  • Jaundice, usually seen in severe cases
  • Fluid build up causing swelling of the abdomen
  • Confusion, caused by a build-up of toxins in the body


How is alcoholic hepatitis diagnosed?

If you come in with signs and symptoms of alcoholic hepatitis, you will be asked about your health history and alcohol use. You may have to undergo some physical examinations too.


The first test we usually carry out is a blood test. By using a blood test, we can check for high levels of liver enzymes, which would indicate damage to your liver.


Diagnosing alcoholic hepatitis is partly a process of exclusion, as other conditions can have similar symptoms, such as hepatitis A, B, C and E, as well as some autoimmune diseases. Blood tests will be able to rule those out.


A liver biopsy is a definitive test, which would confirm our diagnosis from the blood test and show the severity of the damage. A liver biopsy involves taking a small sample of your liver to look at under a microscope. It is not an operation, and can be done as a day case procedure. 


Can alcoholic hepatitis be reversed?

It can - but not always. Currently, no drug treatment is proven to heal the damage done to your liver by excess alcohol consumption. The only way to reverse these effects is to stop drinking.


If the disease is caught early, your liver will be able to heal itself over time once you quit alcohol. If there is significant damage, then, unfortunately, it may be permanent. However, you should still stop drinking to avoid further damage and additional complications.


For people with severe liver damage, their risk of death is quite high. However, those who stop drinking increase their chance of survival by 30% in comparison to those who keep on drinking. If alcohol consumption continues, alcohol hepatitis will likely progress to cirrhosis - the late stage of liver scarring. Having cirrhosis increases the risk of liver failure and liver cancer.


Fortunately, we can manage the complications of alcoholic hepatitis. A treatment plan will be offered to you, which includes regular, close follow-ups and additional support to help you stay off alcohol. There are also excellent counselling and support services that can help you with your alcohol addition which we can refer you to. 


If you are worried about your liver health or you are experiencing any of the symptoms mentioned in this article, you should see a doctor. You can book an appointment with Professor Shahid A Khan by going to his Top Doctors profile.

By Professor Shahid Khan

Professor Shahid A Khan is a leading Consultant Physician based in London who sees patients at  The London Clinic,  BMI The Clementine Churchill Hospital and the Lindo Wing at St Mary's Hospital, London. He specialises in Hepatology & Gastroenterology and treats various conditions relating to Liver disease and Gastroenterology. He is a Professor of Practice in Hepatology at Imperial College London, having been appointed as a consultant there in 2007.

Professor Khan also has specialist accreditation in General Internal Medicine. He qualified from Guy's Hospital Medical School in 1994 and underwent house-officer posts at Greenwich District Hospital and Guy's Hospital. Professor Khan trained as a senior house officer at Hammersmith, Charing Cross, St Thomas', and West Middlesex Hospitals. He then went on to become a Specialist Registrar in Gastroenterology.

Between 1999 and 2002 he was a Clinical Research Fellow at Imperial College London. He was awarded a PhD from the University of London in 2003 for his studies in liver cancer. Professor Khan completed his senior gastroenterology and specialist Hepatology training at St Mary's Hospital and University College Hospital in London. Professor Khan became a Fellow of the Royal College of Physicians in 2010.

He has since been running a general hepatology and gastroenterology service and founded a dedicated clinic for decompensated cirrhotic patients and also for primary liver cancer. He is also the academic and clinical lead for liver cancer and is a designated endoscopy trainer.

Professor Khan is a certified Royal College of Physicians Educator and teaches both undergraduates and postgraduates. He was the Course Director of the Gastroenterology & Hepatology BSc programme at Imperial College London for several years and is currently the Director of Admissions and Inclusivity for Imperial College School of Medicine. He has received several Teaching Awards at Imperial College London. He also speaks Urdu and Hindi fluently.

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