Can Alcoholic Hepatitis Be Reversed? (2025)

Alcoholic hepatitis, also known as alcohol-induced hepatitis, is liver inflammation caused by drinking large amounts of alcohol over many years. It is a more advanced stage of alcohol-associated fatty liver disease (AFLD), in which the high consumption of alcohol causes a buildup of fat in the liver, leading to liver inflammation (hepatitis).

The symptoms of alcoholic hepatitis are similar to other forms of hepatitis, including fatigue, nausea, upper-right abdominal pain, and jaundice (yellowing of the skin and eyes). Stopping alcohol can potentially reverse liver injury before it leads to cirrhosis, the most advanced stage of AFLD.

This article explains how alcoholic hepatitis develops and ways to recognize it when it occurs. It also describes how alcoholic hepatitis is treated, including its impact on life expectancy.

Alcohol Consumption and Alcoholic Hepatitis

The criteria for alcoholic hepatitis, as defined by the National Institute of Alcoholism and Alcohol Abuse, is the rapid onset of jaundice after the high consumption of alcohol for at least six months. High consumption translates to over 40 grams (g) of alcohol per day in females and over 50 g of alcohol per day in males (with one standard drink equaling 14 g).

With that said, alcoholic hepatitis is not dose-dependent. Although alcoholic hepatitis can occur within a relatively short period (particularly in those who binge drink), it is more often seen in people with a long history of heavy alcohol use, typically those who consume eight to 10 drinks per day for 10 years or more.

From Fatty Liver Disease to Alcoholic Hepatitis

Alcoholic hepatitis is a manifestation of alcohol-associated fatty liver disease, also known as alcoholic liver disease. With AFLD, the overconsumption of alcohol causes the accumulation of fat in the liver, known as hepatosteatosis.

While hepatosteatosis is largely asymptomatic (without symptoms), the underlying inflammation can build as the fatty deposits increase, eventually leading to symptoms of hepatitis.

Hepatitis disrupts the normal function of the liver. Among other things, it speeds up the normal breakdown of red blood cells in the liver. This breakdown leads to the excessive release of a yellowish waste product called bilirubin, which causes jaundice.

Between 10% and 20% of people with alcoholic hepatitis will progress to cirrhosis. This is a more advanced stage of AFLD characterized by the accumulation of scar tissue in the liver and the progressive loss of liver function.

How Do Alcoholic Hepatitis Symptoms Begin?

Alcoholic hepatitis is characterized by the rapid onset of hepatitis symptoms, otherwise known as acute hepatitis. The symptoms may start mildly and become progressively worse if drinking continues.

Signs and symptoms of alcoholic hepatitis include:

• Fatigue
• Fever
• Itchiness
• Generalized weakness
  
• Loss of appetite
  
• Upper-right abdominal swelling, tenderness, or pain
• Nausea or vomiting
• Jaundice

In severe cases, alcoholic hepatitis can lead to the buildup of fluid in the abdomen, called ascites, and neurological symptoms such as confusion, reduced alertness, and personality changes due to hepatic encephalopathy. Both are signs of severe liver dysfunction.

Importance of Early Diagnosis

Recognizing the signs of alcoholic hepatitis is the first step to preventing the progression of liver disease. An extensive evaluation is needed to differentiate AFLD from conditions with similar symptoms, like hepatitis B, hepatitis C, autoimmune hepatitis, or metabolic dysfunction-associated steatohepatitis (MASH).

Medical Review and Physical Exam

The diagnosis of alcoholic hepatitis starts with a review of your medical history and a physical exam.

During the physical exam, the healthcare provider will look for other signs, such as spider angioma (spider veins), palmar erythema (palm redness), tachycardia (rapid heartbeat), tremors, and peripheral edema (swelling of the ankles and feet). All of these are common in people with alcohol use disorder (alcoholism).

The provider will also ask questions to determine if alcohol is the likely cause, including:

• How often do you drink alcohol?
• How many drinks do you consume in one sitting?
• How often do you drink six or more drinks in one sitting?

Lab Tests and Procedures

Based on the initial findings, your healthcare provider will order tests to help firmly establish AFLD as the cause of your symptoms.

These typically include:

• Urinalysis: A urine test can detect compounds like ethyl sulfate and ethyl glucuronide that are increased when alcohol is heavily consumed.
• Complete blood count (CBC): This panel of blood tests can detect abnormalities commonly seen with heavy alcohol use, including high neutrophils (a type of white blood cell) and low platelets (a blood cell active in clotting).
• Serum phosphatidylethanol: This blood test can detect phosphatidylethanol, a compound that occurs only in the presence of alcohol.
• Liver function tests (LFTs): This panel of blood tests can help establish if alcohol is the cause based on the ratio of enzymes aspartate aminotransferase(AST) andalanine aminotransferase(ALT).

Other procedures may be ordered to characterize the severity of AFLD and determine if cirrhosis is present:

• Fibroscan: This noninvasive form of abdominal ultrasound is designed specifically to detect and measure liver fibrosis (scarring).
• Liver biopsy: This is the extraction of a sample of liver tissue, usually with a hollow core needle, to diagnose hepatosteatosis, cirrhosis, and other liver diseases, like liver cancer.

MELD Scoring

The treatment of alcoholic hepatitis is directed by classification systems that score the severity of liver disease. The system most commonly used is the Model for End-Stage Liver Disease (MELD) score, which classifies liver disease based on the results of liver function tests.

MELD scores range from 6 for mild liver dysfunction to 40 for severe liver disease. MELD scores can also predict the likely outcome (prognosis) of treatment.

Reversing Alcoholic Hepatitis

Mild alcoholic hepatitis doesn't usually cause any damage and can be reversed by stopping alcohol use. For those who quit, liver enzymes will usually return to normal within a few months. Continued cessation can also reverse AFLD.

Continued heavy drinking can increase the risk of cirrhosis, which largely is irreversible.

Cirrhosis is caused by the dysfunction of hepatic stellate cells (HSCs), which secrete collagen to maintain the liver's structural integrity. When exposed to persistent inflammation, HSCs overproduce collagen, causing a tangle of cells that progressively scar and damage the liver.

Cirrhosis is considered compensated when the liver is still functional. When the damage is so extensive as to cause liver failure, you are said to have decompensated cirrhosis. With end-stage liver disease, a liver transplant is the only means of survival.

Effect on Life Expectancy

Though alcoholic hepatitis is largely reversible once drinking is stopped, it is not always so. In some people, the damage can be permanent and even deadly.

In cases of severe alcoholic hepatitis, an extreme drop in platelets can lead to bleeding in the gastrointestinal tract known as variceal hemorrhage. Along with ascites and hepatic encephalopathy, variceal bleeding is associated with an increased risk of death.

Studies suggest that severe alcoholic hepatitis is associated with a 180-day mortality (death) rate of 40%. Moreover, it increases the risk of cirrhosis ninefold compared to people with mild hepatitis.

While it may be reasonable to assume that the risk increases with the amount of alcohol you drink, factors like genetics, sex, and weight can predispose you to severe hepatitis at far lower levels.

Smoking can also contribute by increasing the risk of portal hypertension (high blood pressure in the portal vein of the liver). This increases the risk of variceal bleeding and irreversible liver damage.

Predicting Survival

Life expectancy can also be estimated based on MELD scores. The MELD score is typically used to prioritize who gets a liver transplant but can also be useful in determining survival in people with alcoholic hepatitis.

The MELD score predicts life expectancy based on the observed mortality (meaning the percentage of people who will die within a specific time frame). The 90-day observed mortality for alcoholic hepatitis is currently described as follows: