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Treatments and drugs
By Mayo Clinic staffComplete abstinence from alcohol is the single most important treatment for alcoholic hepatitis. It's the only way to reverse liver damage or, in more advanced cases, to prevent the disease from becoming worse. Without treatment, the majority of people with alcoholic hepatitis eventually develop cirrhosis.
If you are dependent on alcohol and would like help, your doctor can recommend a therapy that's tailored for your needs. This might be a chemical dependency evaluation, a brief intervention, counseling, Alcoholics Anonymous, an outpatient treatment program or a residential inpatient stay.
Other treatments for alcoholic hepatitis include:
- Nutritional therapy. This is a crucial part of treating alcoholic hepatitis because malnutrition contributes to liver damage. A doctor or dietitian is likely to recommend a high-calorie, nutrient-dense dietary plan to help liver cells regenerate. Doctors also often recommend reducing dietary fat because alcohol interferes with the normal metabolism of fatty acids, leading to deposits of fat in the liver (alcoholic fatty liver). In some cases, medium-chain triglycerides may be prescribed as a supplement. This is a type of fat that may actually help reduce the buildup of harmful fats in the liver. Supplementing with vitamins and minerals depleted by alcohol — especially vitamins B-1, B-2 and B-6 and calcium and iron - also is key.
- Lifestyle changes. Quitting smoking and maintaining a healthy weight can help improve liver function. Smoking has been shown to increase the rate of liver scarring in people with alcoholic hepatitis, and obesity contributes to fatty liver. Additionally, it's essential that you don't use illicit drugs because these can further damage your liver.
- Drug therapies. People with severe alcoholic hepatitis may benefit from short-term treatment with corticosteroids to reduce inflammation and with pentoxifylline, a drug that prevents the body from making tumor necrosis factor-alpha, a powerful substance linked to inflammation. Other therapies that inhibit tumor necrosis factor, such as etanercept (Enbrel) and infliximab (Remicade), also may be considered.
- Antioxidants. Harmful oxygen molecules called free radicals play a major role in alcoholic hepatitis by causing extensive damage to liver cells. Treatment with antioxidants can help prevent this damage. The supplement SAMe may be of some benefit. Other natural supplements, such as the herb milk thistle, also may be helpful, though study results have been mixed. The chief constituent of milk thistle, silymarin, may aid in healing and rebuilding the liver by stimulating the production of antioxidant enzymes. Don't take any supplements or over-the-counter preparations without consulting your doctor because your damaged liver doesn't process these substances as efficiently as it should, and some herbs and supplements can be damaging, even to healthy livers.
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Liver transplant. When liver function is severely impaired, a liver transplant may be the only option for some people. Although liver transplantation is often successful, the number of people awaiting transplants far exceeds the number of available organs. For that reason, liver transplantation in people with alcoholic liver disease is controversial.
Some medical centers won't perform liver transplants on people with alcoholic liver disease because they believe a substantial number will return to drinking after surgery, won't take the necessary anti-rejection medications, or will require more care and resources than will other patients. Most of these objections have not been borne out in practice, however, and many doctors now feel that some people with alcoholic liver disease are good candidates for transplant surgery. But requirements are still stringent, including abstinence from alcohol for at least six months before surgery and enrollment in a counseling program.
