Hepatitis (inflammation) of the liver is alcoholic hepatitis, which is caused due to excessive intake of alcohol. Normally, it is associated with the fatty liver which is an early stage of alcoholic liver disease. This contributes to the progression of fibrosis which leads to cirrhosis.

Classical signs of alcoholic hepatitis would include fluid accumulation in the abdominal cavity (ascites), jaundice, fatigue, and brain dysfunction due to liver failure (hepatic encephalopathy). Though mild cases are self-limiting, severe cases have a high risk of death. Moderate cases would suffer only liver enzyme elevation whereas severe cases would have either dulled consciousness or a combination of elevated bilirubin levels and prolonged liver failure.

Cirrhosis caused by long-term alcohol consumption is distinct from alcoholic hepatitis. Alcoholic hepatitis can occur in patients with both chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic liver disease is a spectrum. Mostly all heavy drinkers have fatty liver changes and develop fibrosis which progresses to cirrhosis. 1–2% diagnosed with this disease end up with hepatocellular carcinoma. Alcoholic hepatitis is a clinical syndrome characterized by acute hepatic decompensation that results from long-standing alcohol abuse. Binge drinkers are also at a risk for alcoholic hepatitis. But research shows that the association between drinking pattern and developing alcoholic hepatitis are limited.

Women have a higher risk of developing alcoholic hepatitis more than men. An observation attributed to the effect of estrogen on oxidative stress and inflammation, lower gastric alcohol de-hydrogenated levels which are in the slower break-up of metabolism of alcohol. Higher body fat content is the cause of a lower volume of distribution of alcohol as compared to men. Alcoholic hepatitis is also influenced by demographic and genetic factors. Nutritious status and co-existence of other liver diseases are also problems. Most patients with alcoholic hepatitis are active drinkers, but it can develop even after reducing or stopping alcohol consumption.

People with alcoholic hepatitis are usually prone to develop bacterial infection and about 7% develop hepatorenal syndrome. According to a study by the Centers for Disease Control and Prevention, only one in six adults discussed alcohol consumption with a health professional. Most patients who suffer from alcoholic liver disease in general and alcoholic hepatitis, in particular, deny alcoholic abuse or under-report their intake. Early management of alcoholic abuse is important in all patients with alcoholic hepatitis. A sudden decrease or discontinuation of alcohol use could cause a risk of alcohol withdrawal syndrome. Usually, patients experience increased heart rate and blood pressure along with irritability and hyperreflexia within 24 hours after the last drink. Complications like seizures and delirium tremens could also arise in the next few days. Nutritional support should be given and deficiency of vitamins A and B, thiamine, folate, pyridoxine and zinc should be taken care of.

Alcoholic hepatitis is a severe manifestation of alcoholic liver disease. It is rising in incidence alarmingly. The cornerstone of treatment would be complete abstinence from alcohol. Excessive alcohol consumption is common worldwide and is a major risk factor for liver disease and is also a leading cause of preventable death.