Alcoholic Liver Disease

Alcoholic liver disease (ALD) refers to a spectrum of liver injury caused by excessive and prolonged alcohol consumption. It encompasses three main stages: alcoholic fatty liver disease (steatosis), alcoholic hepatitis, and alcoholic cirrhosis. In steatosis, fat accumulates in liver cells as a direct toxic effect of alcohol metabolism; this is largely reversible with abstinence. Alcoholic hepatitis represents acute-on-chronic liver inflammation and can vary from mild to severe (Maddrey discriminant function ≥32), with severe cases carrying a 30-day mortality of up to 50%. Long-term heavy drinking ultimately leads to fibrosis and cirrhosis — the irreversible end-stage of ALD.

Symptoms depend on the stage of disease. Fatty liver is usually asymptomatic, detected incidentally on imaging. Alcoholic hepatitis presents with jaundice, tender hepatomegaly, fever, nausea, and coagulopathy. Cirrhosis leads to all the complications of end-stage liver disease: ascites, variceal haemorrhage, encephalopathy, and susceptibility to spontaneous bacterial peritonitis. Diagnosis is confirmed through liver function tests, imaging (ultrasound, MRI), and — when necessary — liver biopsy. Biomarkers such as AST:ALT ratio >2 and elevated GGT are characteristic of ALD.

The cornerstone of ALD management at all stages is complete and sustained alcohol abstinence. Nutritional support, thiamine supplementation, and treatment of complications are key components of care. Severe alcoholic hepatitis may be treated with corticosteroids (prednisolone) or pentoxifylline in selected patients. For end-stage alcoholic cirrhosis, liver transplantation is considered after a mandatory period of documented abstinence (typically 6 months) and psychological assessment confirming commitment to sobriety. Our multidisciplinary team carefully evaluates transplant candidates with ALD to ensure the best possible outcomes.