Alcoholic hepatitis and hepatitis C bear the dubious distinction of being two of the most common liver diseases in the United States. Both can eventually lead to severe, distorting liver scarring known as cirrhosis. A cirrhotic liver may ultimately fail if the underlying disease is not controlled. Alcoholic hepatitis and chronic hepatitis C can occur simultaneously -- a highly dangerous situation as the combination results in additive liver damage and greater risk for life-threatening complications. While alcoholic hepatitis and hepatitis C both involve inflammation and can lead to liver failure, there are significant differences in the cause, risk factors, signs and symptoms, disease course and treatment.
Cause and Role of Inflammation
Hepatitis refers to liver inflammation, which can occur for many reasons. Hallmark characteristics of liver inflammation include a massive influx of immune system cells into the liver and death of a variable number of liver cells.
Hepatitis C involves long-term liver inflammation due to infection with the hepatitis C virus, or HCV. Both the virus itself and the immune system’s response to it contribute to liver inflammation with chronic hepatitis C. Alcoholic hepatitis describes liver inflammation that typically develops suddenly, and is often superimposed on underlying liver damage or fat accumulation associated with long-term, heavy drinking. Approximately 10 to 35 percent of people with alcohol-related liver disease develop alcoholic hepatitis, according to practice guidelines from the American Association for the Study of Liver Diseases, or AASLD.
Signs and Symptoms
Hepatitis C is notoriously silent -- meaning it causes few, if any, obvious symptoms until the disease progresses to liver failure. However, the Centers for Disease Control and Prevention reports that approximately 20 to 30 percent of people experience symptoms at some point during the first 6 months after HCV infection, known as acute hepatitis C. These usually mild symptoms might include low fever, body aches, digestive system upset, and yellowing of the skin and whites of the eyes known as jaundice. Symptoms typically occur 1 to 3 months after infection and gradually disappear over a few weeks. Resolution of these symptoms, however, does not necessarily indicate the infection is gone. Seventy-five to 85 percent of people who contract HCV develop chronic hepatitis C, reports CDC. This means the infection persists beyond 6 months and can only be cured with virus-eradicating medications.
Alcoholic hepatitis is usually an abrupt illness with symptoms of varying severity. Common signs and symptoms include jaundice, fever, nausea, vomiting, poor appetite, lack of energy, pain in the upper right abdomen, liver enlargement and rapid heart rate. People with underlying cirrhosis and those who are malnourished typically experience more severe symptoms with alcoholic hepatitis.
The usual disease course differs with hepatitis C and alcoholic hepatitis. Hepatitis C progresses slowly over decades. Ongoing, low-level liver inflammation stimulates liver scarring, known as fibrosis. Accumulation of this scar tissue can eventually lead to cirrhosis in some people. Untreated hepatitis C results in cirrhosis in 5 to 20 percent of people after 20 to 30 years. People who develop cirrhosis are at risk for life-threatening liver failure and liver cancer. One to 5 out of every 100 people with chronic hepatitis C in the United States dies of the disease, according to CDC.
The development of alcoholic hepatitis in people with alcoholic liver disease has ominous implications. Approximately 50 percent of people who do not already have cirrhosis when alcoholic hepatitis occurs will go on to develop the condition, according to AASLD. The development of cirrhosis might occur even if alcohol consumption stops. Additionally, severe alcoholic hepatitis can cause death within days to months, particularly in people who already have cirrhosis and signs of liver failure.
The obvious risk factor for alcoholic hepatitis is heavy drinking. While there is individual variation, the risk threshold for developing alcoholic liver disease is more than an average of 2 drinks per day for men and 1 drink daily for women, according to the American College of Gastroenterology and the National Institute on Alcohol Abuse and Alcoholism. The risk for alcoholic hepatitis increases with increasing daily alcohol consumption. There is no set time frame for the development of alcoholic hepatitis -- but it might occur within as little as 1 to 5 years with heavy drinking, according to a May 2011 review of the medical literature published in the "World Journal of Hepatology."
HCV is a blood-borne virus, meaning it is transmitted when the virus gains entry into the bloodstream of an uninfected person via the blood or body fluids of someone with the infection. The most common risk factor for contracting HCV is sharing injection drug equipment, even if it was only once or many years ago. People who received a blood transfusion, organ transplant or blood products -- such as blood-clotting factors for a bleeding disorder or gamma globulin to help fight infections -- prior to the establishment of HCV screening of these products in the late 1980s and early 1990s are also at high risk for hepatitis C.
Abstinence from drinking is the most essential component of alcoholic hepatitis treatment. Nutritional therapy to ensure adequate protein, calories, vitamins and minerals is also important for people with alcoholic hepatitis and advanced liver disease, as many are malnourished. The steroid medication prednisolone and another medicine called pentoxifylline (Pentoxil) are sometimes used to reduce liver inflammation in people with severe alcoholic hepatitis.
For people with hepatitis C, treatment with antiviral medicines to eliminate HCV is recommended by AASLD and the Infectious Diseases Society of America. Eliminating the virus from the body typically halts liver inflammation, allows for partial or complete healing of previous liver damage, and significantly reduces the risk for life-threatening liver complications, especially if treatment occurs before cirrhosis develops.
Talk with your doctor about hepatitis C testing if you have risk factors for the illness or were born from 1945 through 1965 -- the age group with the highest rate of HCV infection.
It’s also important to talk with your doctor if you drink heavily or did so in the past. While many people hesitate to talk about their drinking, remember that alcohol addiction is a disease and treatment is available to help you overcome problem drinking.
Medical advisor: Tina St. John, M.D.
- Advanced Therapy in Gastroenterology and Liver Disease; Theodore M. Bayless and Anna Diehl
- Hepatology: AASLD Practice Guidelines: Alcoholic Liver Disease
- Centers for Disease Control and Prevention: Hepatitis C FAQs for Health Professionals
- Hepatology: MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis
- American College of Gastroenterology: Alcoholic Liver Disease
- National Institute on Alcohol Abuse and Alcoholism: Drinking Levels Defined
- World Journal of Hepatology: Symptoms and Signs of Acute Alcoholic Hepatitis
- AASLD/IDSA/IAS–USA: Recommendations for Testing, Managing, and Treating Hepatitis C: When and in Whom to Initiate HCV Therapy
- World Health Organization: Harmful Use of Alcohol: Alcohol Use Disorders and Alcoholic Liver Diseases