In general, prognosis of alcoholic fatty liver disease is determined by the degree of hepatic fibrosis (liver scarring) and inflammation. Fatty liver and alcoholic hepatitis without fibrosis are reversible if alcohol is avoided. With abstinence, fatty liver completely resolves within a six week period. Fibrosis and cirrhosis are irreversible.
To better understand the above, I will try to explain alcoholic fatty liver disease briefly:
Liver disease related to alcohol consumption fits into 1 of 3 categories:
1- Fatty liver, which occurs after acute alcohol ingestion, is generally reversible with abstinence and is not believed to predispose to any chronic form of liver disease if abstinence or moderation is maintained.
2- Alcoholic hepatitis is an acute form of alcohol-induced liver injury that occurs with the consumption of a large quantity of alcohol over a prolonged period of time; the severity of the liver damage ranges from disturbances in the liver blood tests without symptoms, to liver failure and death.
3- Cirrhosis: the normal liver tissue gets replaced with thick hard scar tissue, which results in elevation of blood pressure inside the liver and liver failure.
The prevalence of alcoholic liver disease is under the influence of many factors, including genetic factors (e.g., predilection to alcohol abuse, gender, obesity) and environmental factors (e.g., availability of and accessibility to alcohol, social acceptability of alcohol use, concomitant use of drugs or other substances that also cause liver damage), and it is therefore difficult to define. In general, however, the risk of liver disease increases with the quantity and duration of alcohol intake. It is also worthy of noting that excessive alcohol use alone is not sufficient to promote alcoholic liver disease: only 1 in 5 heavy drinkers develops alcoholic hepatitis, and 1 in 4 develops cirrhosis.
With abstinence, changes of the fatty liver usually revert back to normal; the time required for reversal of liver damage depends on:
1- the extent of the damage that has occurred in the first place.
2- The commitment of the patient to full abstinence
3- Adequate diet
4- Compliance to treatment or rehabilitation program, if any is needed
Moreover, and despite the fact that patients with alcoholic steatosis usually do very well, with longer follow-up it has been found that cirrhosis develops more commonly in alcohol abusers with fatty liver changes than in those with normal liver.
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