Alcohol-related liver disease (ARLD)

It’s important to have regular appointments with your doctor or specialist so they can monitor your condition. They will be able to provide you with more information on how often these should be, who with and what to expect. If you have cirrhosis, you’ll need monitoring every six months for the rest of your life, which will include checking (surveillance) for a type of liver cancer called hepatocellular carcinoma.

You should also have fibrosis tests to check the scarring in your liver every 2 years. This is important because there are often no symptoms to alert you or your doctor if your disease getting worse.

If you have alcohol-related fatty liver, the damage may be reversed if you stop for a period of time (months or years). After this, it’s usually safe to start drinking again if you stick to the recommended government guidelines. Speak to your doctor if you are thinking of starting drinking again, if you have a dependence on alcohol it may not be safe to start again.

If you have a more serious form of alcohol-related liver disease, such as alcohol-related hepatitis or cirrhosis, your doctor will advise you to stop drinking completely (lifelong abstinence) to prevent further damage.

Lots of people find it hard to stop drinking or cut down, so ask your doctor for help if you need it. They can refer you to specialist advice and support from alcohol services. If you have consumed a lot of alcohol over a long period of time, you may need medical assistance (a medical detox) to help your body cope without alcohol to start with.

If you’re dependent on alcohol, you can experience alcohol withdrawal symptoms if you suddenly stop drinking, so your doctor might recommend cutting down your alcohol intake slowly rather than stopping straight away. Reducing the amount of alcohol you drink can still lead to a significant improvement in your condition.

You might be offered medication and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases so their progress can be closely monitored. If you’re at home, you’ll need to regularly see a nurse or another health professional. This could be at home, at your GP surgery or at a specialist NHS service.

Once you have stopped drinking, you might need further medical treatment to help ensure you do not start drinking again.

A lot of people with alcohol-related liver disease are malnourished. Not getting the right nutrients from your diet makes it harder for your liver to recover, so eating well is key to treating your condition.

For earlier stage alcohol-related liver disease, focus on eating a healthy balanced diet that includes lots of vegetables, fruit, wholegrain carbohydrates (such as wholemeal bread or brown rice) and lean protein (such as chicken, fish or tofu). Cut down on highly processed foods and snacks, especially those that are high in fat, sugar, or salt.

If you have alcohol-related hepatitis or cirrhosis, as well as eating a healthy balanced diet you may need to follow special advice to make sure you get enough energy (calories) and protein, and not too much salt. This will help prevent muscle wasting and weakness. Read detailed information about eating well with cirrhosis.

In some serious cases of malnutrition, you may need to be fed through a tube (enteral nutrition). The tube is very thin, it goes up your nose and then through your food pipe and into your stomach. This is often lifesaving, but requires very specialist expertise and care to avoid harm. Many patients can be taught to use the tube feeding system at home and isn’t uncomfortable to use.

It’s important to keep your weight healthy, as this helps stop more damage to your liver. Carrying extra bodyweight can cause liver damage too. And if you are underweight it could be a sign that you are malnourished. If you need to lose or gain weight ask your doctor for advice on diet tailored to you.

Doing regular physical activity or exercise can help keep you strong and prevent muscle wasting. Do what you can manage each day – doing something, even something small, is much better than nothing. Find out more about being active.

Talk to your clinical team before making any changes to your diet, they know you best and can give you personalised advice. Your diet and nutrition should be regularly reviewed by a liver specialist or dietitian with experience in advising liver disease patients, to ensure you are given the right advice based on your individual needs.

The use of medication to directly treat alcohol-related liver disease is complex and there’s generally a lack of good evidence to support its effectiveness. As there’s no one-size-fits-all approach it’s important you have a specialist co-ordinating your care and that you understand the plan they have put in place for you.

If you have severe alcohol-related hepatitis, you may need to be treated in hospital. Specialists may use anti-inflammatory medication in some patients to reduce liver damage, such as steroids (corticosteroids).

Corticosteroid treatment:

• Has been shown to improve survival in the short term (1 month)
• Has not been shown to improve survival over a longer term (3 months to 1 year)
• Increases the risk of serious infections within the first 3 months of starting treatment.

Other medicines that can be used to treat liver disease and its complications include antibiotics and heart medicines, like beta blockers. These are classed as off-label or unlicensed medicines, meaning that the medicine isn’t licensed for treatment of your condition. But the medicine will have a licence to treat another condition and will have undergone clinical trials for this. Your doctor may recommend these if they think it will treat your condition effectively and the benefits are greater than any risks.

If you have been admitted to hospital with alcohol-related liver disease, it’s really important that before you are discharged you ask about aftercare. If you don’t get the information you need about managing your condition at home, speak to your doctor.

If your liver is very badly damaged, a liver transplant could be life-saving. It’s usually only recommended if other treatments are no longer helpful, and your life is threatened by end stage liver disease.

There’s a general assumption that if you have later stage alcohol-related liver disease you can’t have a liver transplant, but this isn’t true. Things have changed, which means you can be eligible if it’s the right treatment for you. To be eligible you must have stopped drinking completely. Your liver specialist will try to treat your liver disease for a couple of months before considering referring you to a transplant specialist.

Anyone with liver disease can have a transplant assessment if they meet certain conditions. This will be carried out at a liver transplant unit, and the process usually takes about a week. You may need to stay in hospital during this time, or you may be able to go home at the end of each day.

The assessment involves talking to liver transplant specialists and having tests to check your liver and general health, including the strength of your heart and lungs.

As surgery is very technical, people who have a transplant will need to spend some time in the Intensive Care Unit (ICU) after their operation.

Liver transplants are very successful. They are a major operation so it can take up to a year to recover, most people are able to leave hospital around 10 days after surgery.

Once you’ve had a transplant you’ll need lifelong treatment with medication to control your immune system. This is managed by your transplant specialist or hepatologist.

If you have later stage liver disease it’s really important to ask your liver specialist about having a transplant. There are 7 transplant units in the UK and they will tell you which one they usually refer to. Read or download more information about liver transplants here.