The leading cause of alcohol-related deaths can go unnoticed for years

Alcohol-related liver disease is the main cause of death from excessive drinking – and although it is curable in its earliest stages, many people do not realize until it is too late to reverse it.

The number of annual deaths from the disease is increasing in the United States, after rising 39 percent in recent years, new research shows. facts of the Center for Disease Control and Prevention. Death rates are highest among men and adults aged 50 to 64, although they are rising faster among women and younger adults.

“People who drink drink more heavily than before, so I think that’s the biggest factor,” says Dr. Jessica Mellinger, assistant professor of gastroenterology and hepatology at the University of Michigan Medical School. And, she added, “we see that for the first time in this country, women are drinking as much as men.”

What is alcohol-related liver disease?

The first stage of the disease is fatty liver or steatosis. This happens when fat starts to accumulate in the liver, which is responsible for metabolizing alcohol. In the second phase, excessive alcohol consumption activates the body’s immune system, causing inflammation in the liver.

“The two main ways you can damage your liver are by putting fat in it and then by adding inflammation to the fat,” said Dr. Mellinger.

If that damage continues, scar tissue can build up in the liver, leading to the third stage: cirrhosis. About 20 percent of people with alcohol-related fatty liver disease will progress to cirrhosis.

Some people also develop alcohol-related hepatitis, which is a serious inflammation of the liver. This occurs most often in people with cirrhosis, but it can happen at any stage if people drink very heavily (eight to ten drinks a day). Both liver cirrhosis and alcohol-related hepatitis can be fatal.

What causes it?

The risk of alcohol-related liver disease increases when people drink more than the recommended limits: seven drinks per week for women and fourteen for men. It goes up significantly for women who regularly consume more than three drinks per day and men who drink more than four drinks per day, said Dr. Sasha Deutsch-Link, a fellow in gastroenterology and hepatology at the University of North Carolina at the Chapel Hill School. of medicine. (Because women metabolize alcohol differently men are at greater risk of disease if they drink the same amount.)

Alcohol consumption is estimated at that level 90 percent of people have fatty deposits in their liver. The fat can start to accumulate quickly — in some cases after just six months of heavy drinking, said Dr. Rohit Loomba, chief of gastroenterology and hepatology at UC San Diego Health.

Cirrhosis takes years or decades to develop. As a result, severe liver disease is more common in older adults, although Dr. Deutsch-Link said she had seen 20-year-olds with cirrhosis or alcohol-related hepatitis.

Metabolic conditions, such as obesity, diabetes or high blood pressure, can also damage the liver. This puts people at “an increased risk of developing liver disease more quickly with lower alcohol consumption,” said Dr. Deutsch Link. Worsening metabolic health among Americans may be another reason for the rise in deaths from alcohol-related liver disease.

What are the signs of liver damage?

There are no symptoms in the early stages of alcohol-related liver disease, making it difficult to identify.

“The majority of people who may be on their way to developing cirrhosis don’t even know it,” said Dr. Loomba.

When people are diagnosed in the first two stages, it is often because blood tests have revealed abnormal liver function. These tests may be given as part of routine metabolic screening, or a doctor may recommend them if concerned about a patient’s alcohol consumption. If someone’s liver enzyme levels are abnormal, an ultrasound or MRI can determine what stage of liver disease the person is in.

However, liver disease is often only discovered when alarming symptoms appear at a late stage. A patient may have significant fluid and swelling in the abdomen, vomit blood, or develop jaundice.

How is alcohol-related liver disease treated?

Because the liver can regenerate itself, the first two stages of liver disease can be reversed if the patient stops using alcohol.

“The most important thing is to stop alcohol use for these patients,” said Dr. Deutsch Link. To help with this, many liver clinics offer treatments for alcohol use disorders, including therapy, group programs, or medications to reduce alcohol cravings.

Once someone has cirrhosis, “for the most part, it’s considered irreversible,” says Dr. Robert Wong, clinical associate professor of gastroenterology and hepatology at Stanford University School of Medicine. “And once you develop cirrhosis, you are at much greater risk for complications, progression, liver cancer and, unfortunately, of course, death.”

Dr. However, Loomba noted that even with cirrhosis, if people stop drinking, “the risk of dying from cirrhosis in the next year decreases significantly.”

If you’re concerned about the health of your liver, experts say, the first step is to talk to a doctor and ask about liver function tests. The goal is to detect any problems as early as possible.