Alcoholic hepatitis is a very severe inflammatory disease of the liver caused by excessive alcohol consumption. Often asymptomatic, it can have serious consequences.

Hepatitis is an inflammatory liver disease that involves severe damage to the liver. It is characterized by the development of lesions associated with the death of liver cells which alter its functioning and its biological parameters. There are several forms. Hepatitis can be caused by a virus, such as hepatitis A, B and C for example. It can also have other causes such as the accumulation of fat in liver cells unrelated to alcohol (we speak of non-alcoholic steatotic hepatitis) or alcohol consumption. It is the latter that we are talking about here.

There are two forms of alcoholic hepatitis:

• acute, sudden hepatitis immediately after massive alcohol poisoning. Most often symptomatic, it can be extremely serious. This form of hepatitis is very rare in France;
• chronic hepatitis that sets in over time with excessive and regular alcohol consumption. It can be punctuated by more acute episodes. The hepatitis can then develop into cirrhosis and be associated with a risk of short-term mortality. It is the most frequent form in France.

As alcoholic hepatitis is most often asymptomatic, it is difficult to assess its prevalence. It is thought to affect 1 in 5 heavy drinkers. It is associated with liver failure and a high death rate.

The most common cause of hepatitis is alcohol abuse. There is good reason to drink alcohol in moderation for good reason. Indeed, alcohol is a poison for the body. In small doses, it is filtered by the liver and evacuated. In high doses, alcohol damages several organs: the digestive tract which absorbs it, the kidney which filters a small part of it and evacuates it in the urine, the lung which evacuates a small part in the exhaled air and finally the liver which filters the vast majority (90%) of the alcohol absorbed. The liver gets tired and can eventually get sick and not be able to perform its functions properly. The toxicity of alcohol on the liver can occur at doses which may appear low: 20 to 40 grams of alcohol per day, or 2 to 4 drinks in women and 40 to 60 grams of alcohol per day, or 4 to 6 glasses in humans.

The consequences for the liver are as follows, in order of seriousness:

• steatosis or alcoholic hepatitis: fat is deposited in liver cells;
• hepatomegaly: the volume of the diseased liver increases;
• fibrosis: inflammation of the liver leads to the formation of scar tissue;
• cirrhosis: the liver tissue continues to change and becomes hard;
• liver cancer.

These four types of lesions can be observed simultaneously or in isolation. Steatosis and hepatomegaly may be reversible if you stop drinking alcohol immediately.

The risk of developing alcoholic hepatitis is higher in women than in men. This risk is increased in case of overweight or obesity. There is also a genetic predisposition.

Alcoholic hepatitis can be asymptomatic for a very long time and only manifest at an advanced stage. When symptoms do appear, it may be:

• jaundice or jaundice: yellowing of the skin, eyes and certain mucous membranes due to an accumulation of bilirubin (degradation product of red blood cells normally filtered by the liver and evacuated by the urine, for which it is responsible for the color) ;
• ascites: enlargement of the abdomen due to hypertension in the veins that supply blood to the liver;
• hepatic encephalopathy: neurological disorders due to brain damage secondary to liver dysfunction.

The first step in treatment is to reduce or even stop alcohol consumption altogether. In the event of dependence, follow-up in an addiction service and / or by a psychologist can be set up. There are drug treatments to accompany withdrawal.

Withdrawal can be accompanied by diuretic treatment if necessary. The patient may also receive a vitamin supplement. Corticosteroid treatment can be used to reduce inflammation.

After weaning and treatment, in case of irreparable damage inflicted on the liver, it is possible to consider a transplant. The patients entitled to the transplant are rigorously selected and the absence of alcohol consumption is an essential condition.

The death rate from alcoholic hepatitis remains high. Indeed, the therapeutic alternatives are not numerous. The disease is often accompanied by serious infections and malnutrition. The risk of relapse in the event of addiction also remains high.