Alcohol: the modern age liver killer

Alcohol is predominantly metabolized through liver, hence its cumulative toxicity over years play important role in liver diseases or pancreatic diseases.

Research shows that 3-4 drinks (30-40g) for females and 5-6 drinks (50-60g) for males, daily for15 years, cause permanent damage to liver tissue, which is replaced by scarred , non-functional liver tissue (liver cirrhosis) causing liver cell failure.

According to Dr Vinit Shah, consultant hepatologist at BGS Gleneagles Global Hospitals, "Research done by our team in North India, between 2012- 2014, had revealed that alcohol was the most common risk factor for both acute liver damage (alcoholic hepatitis) as well as chronic liver disease (cirrhosis) in adults, which currently goes against previously described risk factors in Indian subcontinent- such as hepatitis B, hepatitis C etc."

Alcohol damages the liver over years with initially excessive fat deposition (Alcoholic steatosis), then followed by repeated episodes of liver swelling (Alcoholic hepatitis). Both are largely asymptomatic conditions picked up mainly through surveillance of liver function through blood tests, ultrasound of liver, fibro-scan (non-invasive assessment of liver fibrosis).

Timely counselling, medical de-addiction, rehabilitation, gives an extremely high chance of complete reversal of liver changes to normal. Most people are completely ignorant of de-addiction and do not abstain causing disease progression, Dr Shah added.

WHO has defined alcohol dependence / alcohol abuse syndromes and in these people go on to develop liver cirrhosis and liver cell failure (decompensation) which manifests as jaundice , gastrointestinal tract bleeding , loss of consciousness (hepatic encephalopathy / liver coma ) , fluid in abdomen (ascites) , infection of fluid (Spontaneous bacterial peritonitis) .

Liver diseases can present itself as decompensated chronic liver disease or acute damage due to alcohol (Alcoholic hepatitis - Acute on chronic liver failure; ACLF). Internationally validated scores such as Meld, CTP and discriminant function calculated from blood parameters such as bilirubin, creatinine, Prothrombin time etc can gauge severity of these conditions.

Both are conditions which without adequate medical management and abstinence from alcohol pose substantial risk to life in as short time as even three months depending on score severity and whether other organs especially kidney are affected. In some cases of cirrhosis due to alcohol there is tendency of damaged liver tissue to transform into liver cancer which also has bad outcome without timely identification.

Alcohol abstinence with periodic reinforcement by deaddiction specialist along with excellent nutritional optimization is the most important cornerstone of treatment. Medical management hinges on addressing complications like ascites, encephalopathy, SBP, GI bleeds, treating infections, correcting other organ failures. Timely expert medical management, abstinence can reverse liver failure in 10-15 percent patients over 3-6 months.

Liver transplantation is the only definitive curative treatment modality in people who continue to have liver decompensation even after adequate optimal medical management, challenges here include ethical issues regarding listing people in cadaveric organ lists and ensuring abstinence after transplantation.