Excessive drinking over decades damages almost every organ in the body; however, the liver can sustain the earliest damage and the greatest degree of tissue injury from excessive drinking because it is the primary site of ethanol metabolism.¹

ARLD is when hepatic lesions develop due to prolonged and heavy alcohol consumption.^1,2The development of ARLD is dependent on several factors; a threshold must be reached regarding the duration of use and daily intake of alcohol.

There are three main stages of ARLD, although there’s often an overlap between each stage.^2,3

1: Steatosis/Alcoholic fatty liver disease

The first stage of alcohol related liver disease is steatosis which is the most common response to high alcohol intake levels and develops in more than 90% of individuals who drink 4-5 standard drinks per day over decades.²

Fatty liver disease rarely causes any symptoms, but it’s an important warning sign that drinking is at a harmful level. It is also reversible, with the liver returning to normal after 2 weeks of abstinence.^2,3

2: Alcoholic hepatitis

Alcoholic hepatitis is a more severe condition that can be caused by alcohol misuse over a more prolonged period.³ Liver injury is characterised by swollen, dying hepatocytes, neutrophilic infiltration, and the development of tangled aggregates of insoluble proteins.² Less commonly, alcoholic hepatitis can occur if shorter binge periods of drinking occur.³

The damage associated with mild alcoholic hepatitis is often reversible if drinking is stopped permanently. However severe alcoholic hepatitis can be serious and life-threatening.³

3: Cirrhosis

Cirrhosis is the late stage of hepatic scarring and is generally not reversible.³ The World Health Organization’s Global Status Report on Alcohol and Health estimated that 50% of all deaths caused by cirrhosis were due to alcohol.²

A patient with alcohol-related cirrhosis who doesn’t stop drinking has less than 50% chance of living for at least 5 more years.³

Whilst there are no approved treatments for ARLD, there are several therapies used for optimal ARLD management to minimise the lasting impacts and symptoms:¹

• Abstinence – Drinking cessation both resolves alcoholic steatosis and improves the survival of cirrhotic patients, and is often considered the most effective therapy. Lifestyle modifications paired with abstinence will enhance the effectiveness of this therapy.
• Natural and artificial steroids – Corticosteroid treatment is extensively used as a form of therapy, especially in patients with moderate to severe alcoholic hepatitis.
• Nutritional supplements – Malnourishment is a common symptom in patients with severe alcoholic hepatitis and cirrhosis due to disease severity and complications, such as variceal bleeding, ascites, infections, encephalopathy and hepatorenal syndrome.
• Liver transplantation – For patients who practice abstinence, liver transplantation remains a standard of care at end-stage liver disease. Other factors which impact suitability for a transplant are higher incidence of cancers in the upper GI tract, or improvement of liver function after abstinence.