Alcohol-related liver disease

Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
Next review due July 2022

Alcohol-related liver disease (ARLD) is damage to your liver caused by years of drinking too much alcohol. At first you may have no symptoms but as time goes on, you may become very unwell.

If you give up drinking in the early stages, the damage to your liver may be reversible. But if you continue to drink, your liver may become permanently scarred and damaged.

A glass of cider

About alcohol-related liver disease

When you drink a lot of alcohol over a long period of time, it damages your liver. There are three main types of damage, which may overlap and happen at the same time:

  • fat building up in your liver cells (fatty liver)
  • inflammation
  • scarring (fibrosis)

Nearly everyone who drinks heavily and regularly will have fatty liver. It can happen after only a few weeks of heavy drinking. Often there are no symptoms and fatty liver may be reversible if you stop drinking.

If you continue to drink, the tissues of your liver become inflamed. This inflammation can range from being a mild and reversible condition to a much more severe one (alcoholic hepatitis), needing admission to hospital.

Fibrosis of your liver happens progressively over many years of drinking. In an attempt to heal itself, some of your damaged liver gets replaced by fibrous scar tissue. Eventually, there may be so much scarring that it affects the whole structure and function of your liver. This advanced condition is called cirrhosis and can lead to major health problems. Cirrhosis isn’t usually reversible but stopping drinking can help prevent further damage.

In general, the more alcohol you drink and the longer you drink for, the more likely you are to get liver damage.

Symptoms of alcohol-related liver disease

If your liver is damaged from drinking too much alcohol, you might not have any symptoms in the early stages. But if the damage gets worse, your liver might struggle to cope and symptoms can develop.

Symptoms of alcohol-related liver disease can be vague and not very specific. You might:

  • feel generally unwell and tired
  • have upper abdominal (tummy) pain on the right side
  • lose your appetite
  • lose weight even though you’re not trying
  • notice that your muscles are weaker and wasting away

If the damage continues to get worse, you might have a range of other signs and symptoms. These include:

  • itchy skin
  • yellowing of your skin or whites of your eyes (jaundice)
  • redness on the palms of your hands
  • hair loss
  • swelling in your abdomen (tummy) and legs, causing you to gain weight unintentionally
  • bruising and bleeding easily
  • feelings of confusion and trouble concentrating and remembering things
  • hormonal changes – testicles may get smaller in men and they may develop more breast tissue; women may have irregular periods

These symptoms aren't always caused by alcohol-related liver disease. But if you have them, contact your GP.

If you have any of the symptoms below, you need to see a doctor urgently as they can be life-threatening:

  • vomiting blood (vomit may look like coffee grounds)
  • very black and tarry stools
  • a high temperature and shivering (fever) which might mean you have an infection
  • confusion and drowsiness
  • shortness of breath
  • sudden onset of jaundice – a yellowy tinge to your skin and the whites of your eyes

Diagnosis of alcohol-related liver disease

Your GP will ask about your symptoms and examine you. They’ll also ask how often you drink alcohol and how much. It’s important to be honest with them. This will help them to understand if you could have liver damage caused by drinking too much alcohol. They may also ask about your medical history.

If your GP suspects that you have liver damage, they may refer you to a hepatologist (a doctor who specialises in conditions of the liver).

Your GP or hepatologist may ask you to have one or more of the following tests.

  • Blood tests to see how well your liver is working, to check your general health and to rule out a liver infection (hepatitis A, B or C). Some people have liver damage despite having normal blood tests.
  • Scans, such as an ultrasound, CT scan, or MRI scan. You may be offered a special kind of ultrasound scan called elastography (usually called a fibroscan) to measure the stiffness of your liver. A fibroscan is a reliable way of finding out if you have liver damage.
  • You may have a liver biopsy, although this is not always necessary. Biopsy means having a small sample of liver tissue removed and examined under a microscope.

Cirrhosis can cause swollen veins in your oesophagus (food pipe) or stomach. These are called varices, and they can bleed. Your doctor may ask you to have an endoscopy to see if you have varices. This means having a sedative and then having a tube with a camera attached (an endoscope) passed into your stomach.

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Treatment of alcohol-related liver disease

The aim of treatment is to help your liver recover, and prevent any damage from getting worse. Your doctor will also want to control as many symptoms as possible and help to stop complications developing. If you have alcohol-related liver disease, the best way to treat it is to stop drinking alcohol.

Stop drinking alcohol

This may be difficult for you to do, but is very important. Alcohol-related liver disease can affect you even if you don’t think you have a problem with alcohol. But if you’re struggling to stop drinking, talking to your GP could be your first step. They can put you in touch with professional services that can help. Or you could contact NHS alcohol addiction services directly. You may find support groups helpful – there are a range of these which may suit different individuals. For contact details of organisations that can offer information, advice and support, see our section: Other helpful websites.

You may be offered tablets to help manage any withdrawal symptoms and reduce your alcohol cravings, if you need them. For some people, going into hospital for medical detoxification treatment is the best option.

Fatty liver and mild alcohol-related inflammation usually recover if you stop drinking. Even if you have more advanced liver disease, giving up drinking will improve your life expectancy.

If you have any underlying problems, such as anxiety or depression, these may get better if you stop drinking alcohol. If they don’t, your GP can help you get the support and any treatment you might need.

Diet and exercise

For most people, drinking a lot of alcohol makes you gain weight. Being overweight can make alcohol-related liver disease worse, so it’s important to try to reach and maintain a healthy weight.

If you have cirrhosis, you may be malnourished and correcting this can help your liver recover and prevent complications. Try to have a healthy balanced diet, making sure you get enough calories as well as all the nutrients you need. If you’re losing weight, your GP or dietitian may suggest you eat frequently, including snacks mid-morning and at bedtime. They may also ask you to take vitamins and diet supplements. If you’re retaining fluid in your body, your doctor may advise you to have a low-salt diet.

You can get lots more information about diet and liver disease from the British Liver Trust (for contact details, see our section: Other helpful websites).

Taking regular exercise might also help you to stay well and prevent muscle wasting. Doctors aren’t certain yet whether exercise helps people with liver disease in particular, but it does bring general health benefits.


There are no specific medicines used to treat alcohol-related liver disease – you need to stop drinking alcohol.

If you have a severe attack of alcoholic hepatitis, you may need treatment in hospital. Your doctor may offer you corticosteroid medicines to reduce the inflammation in your liver.

If you have cirrhosis, your doctor may prescribe medicines including:

  • medicines to stop itching
  • calcium and vitamin D to lower your risk of osteoporosis
  • other vitamin supplements such as thiamine (Vitamin B1)
  • preventive antibiotics to stop you picking up infections
  • a diuretic (water tablet) if you have fluid retention
  • a beta-blocker to reduce the risk of bleeding if you have varices in your oesophagus

If you have cirrhosis, don’t take non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or high doses of paracetamol. These medicines may cause further damage to your liver. NSAIDs can also cause you to retain fluid and can increase your risk of bleeding.

Always read the patient information leaflet that comes with your medicines and if you have any queries, ask your pharmacist.


If you have severe alcohol-related liver disease, your doctor may recommend you have vaccinations against other liver diseases including hepatitis A and hepatitis B. You may also be more vulnerable to other infections and need vaccinations against flu and pneumococcal disease (pneumonia).

Liver transplant

If you develop alcohol-related cirrhosis, you may be offered a liver transplant. This is a major operation to remove your damaged liver and replace it with a healthy liver from a donor. You may only be offered a liver transplant if other treatments haven't worked or you have developed a complication.

To have a liver transplant, you must have stopped drinking alcohol. A transplant is a very big undertaking and, apart from your liver damage, you must be fit enough to have it. Your doctor will be able to advise you whether or not this is a suitable option for you. For more information on drinking alcohol and having a liver transplant, see our FAQs.

If you have a liver transplant, you must not drink alcohol for the rest of your life. You’ll also need to take medicines to prevent your body rejecting your donor liver.

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Causes of alcohol-related liver disease

As its name suggests, alcohol-related liver disease is caused by drinking alcohol – usually many years of heavy drinking. Alcohol-related liver disease doesn't only affect people who have an alcohol addiction or those who often get drunk in binges. If you regularly drink over the recommended alcohol limits of any type of alcohol, you have a higher chance of developing alcohol-related liver disease.

Your liver has many functions, one of which is to process substances like alcohol. Your liver can handle a certain amount of alcohol but drinking heavily and regularly puts a strain on it.

Liver damage builds up gradually over many years. The liver is usually able to repair and renew itself. But if liver cells become too badly damaged, your liver can become permanently scarred. And as scar tissue builds up, it stops your liver from working properly.

There’s no specific amount of alcohol that will cause liver disease – it varies from person to person. But the more alcohol you drink, the higher your chance of damaging your liver. You’re more likely to get alcohol-related liver disease if you’re very overweight or if you have other problems with your liver such as hepatitis C. And the scarring may get worse more quickly if you smoke.

Complications of alcohol-related liver disease

Severe liver damage from alcohol use (cirrhosis) can cause a number of serious complications, including:

  • high blood pressure within the blood vessels around your liver (portal hypertension)
  • fluid in the abdomen
  • organ failure
  • liver cancer

Portal hypertension

Portal hypertension is abnormally high pressure in the veins that carry blood from your intestine to your liver. It’s caused by scar tissue in your liver restricting the flow of blood. It can lead to varices (swollen veins) in your stomach and oesophagus as the blood tries to find new paths to take. These varices can bleed, which is a medical emergency.

If you don’t have varices when you’re diagnosed, your doctor may suggest you have endoscopies in the future to check if you’ve developed them. If you have varices, you can be given treatment for these through an endoscope. Your doctor will explain what this involves.

If your varices are bleeding, your doctor may suggest having a transjugular intrahepatic portosystemic shunt (TIPS). This involves creating a new channel in your liver, which blood can flow through to help relieve pressure.

Fluid in your abdomen

A common complication of cirrhosis is fluid in your abdomen (ascites). Your abdomen becomes swollen due to the build-up of fluid. If this can’t be controlled with diet and water tablets, you may need to have a procedure to have it drained. This is called a paracentesis. Your doctor might suggest having TIPS if your ascites is difficult to control.

If the fluid becomes infected, it can cause abdominal pain and a fever. If this happens you will need urgent medical attention. Overwhelming infection (sepsis) is a serious medical condition and may be life-threatening.

Organ failure

If you have cirrhosis, this may lead to failure of vital organs in your body. As well as your liver not working as well as it should, you may have the following problems.

  • Kidney failure (hepatorenal syndrome) is when your kidney doesn’t get enough blood flow. It may come on rapidly or progress slowly.
  • Problems with how well your brain functions (hepatic encephalopathy) – you may feel confused, lose consciousness, feel sleepy or have trouble sleeping. It can follow an episode of constipation, dehydration, infection or bleeding from the gut. Or it can be caused by taking certain medicines.

Liver cancer

If you have cirrhosis, your risk of getting hepatocellular carcinoma, the most common type of liver cancer, increases. Your doctor may suggest that you have an ultrasound scan every six months to check for this.

Prevention of alcohol-related liver disease

The best way to reduce your chance of getting alcohol-related liver disease is to limit the amount of alcohol you drink or not to drink alcohol at all. Not drinking alcohol can also prevent liver damage progressing if you already have it.

Sensible drinking means staying within recommended limits. In the UK, guidelines recommend that you should not regularly drink more than 14 units over the course of a week. If you do drink as much as 14 units, you should spread it over three days or more, rather than 'saving up' units. Binge-drinking may make you more at risk of getting alcohol-related liver disease.

An easy way to cut back on your intake is to have several drink-free days each week.

To find out what makes up a unit of alcohol, have a look at our information on sensible drinking. We also give tips and hints there on how to drink sensibly. You can get lots of useful information from the organisations listed under our section: Other helpful websites.

Our handy infographic below can help you understand how many units of alcohol are in your drink.

Bupa's units of alcohol in a drink PDF opens in a new window (1.3 MB)

Bupa's units of alcohol in a drink

Frequently asked questions

  • No, you can’t have a liver transplant if you don’t give up alcohol altogether.

    Before you’re considered for a transplant, you’ll be assessed by an alcohol specialist on the transplant team. Depending on their assessment, you may need to have treatment to help you stop drinking and abstain from drinking alcohol in the future.

    You need to have given up alcohol and to be able to show that you’ve addressed any problems you have with drinking before your transplant. If you don’t give up drinking, you won’t be offered a liver transplant.

    You can’t drink after a liver transplant because drinking alcohol could damage your new liver. You’ll be asked to sign an agreement, which states that you won't drink alcohol after your transplant and will take part in regular follow-up assessments. This includes routine blood tests to check that you haven’t had any alcohol.

  • If you have the early stages of alcohol-related liver disease and you continue to drink, your liver will become increasingly damaged. You may develop progressive scarring of your liver leading to cirrhosis.

    If you have cirrhosis, your liver will be scarred and damaged. If you continue to drink, you’ll cause further damage to your liver and it may lead to liver failure. This is where your liver is no longer able to function as it should. It is a serious and life-threatening condition.

    You may not be able to reverse the damage to your liver from cirrhosis. But you can prevent further damage if you stop drinking alcohol and your liver function may improve. If you have cirrhosis and stop drinking, you can improve your chances of living longer.

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Related information

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    • Cirrhosis. BMJ Best practice., last reviewed June 2019
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    • Personal communication, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist, July 2019
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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, July 2019
    Expert reviewer, Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist
    Next review due July 2022

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