COVID-19 has rightfully dominated the news over the past several months. This virus directly affects many organ systems such as the respiratory system, the gastrointestinal tract, the kidneys, the brain and our ability to clot but interestingly, the quarantine and social distancing associated with the pandemic have also led to changes in behavior and health. Overall, social distancing and staying at home has led, in many cases, to decreased exercise activity, weight gain and significantly increased alcohol use. As regards the liver, these behavioral changes are worrisome. Weight gain can lead to fatty liver which over time can lead to liver inflammation, scarring and eventually cirrhosis. These changes associated with weight gain do not happen over the course of weeks and months but rather take years and are reversible with exercise, dieting and weight loss meaning there is hope that the weight gained during the COVID crisis can be shed once we are allowed back out to our previous routines.
The significant increase in alcohol use is more worrisome. As people cannot go out and are home from work, working from home or unemployed, there is a definite and quantifiable rise in the amount of home alcohol consumption that we are seeing. Whether this increased use is a result of boredom, depression or “internet” cocktail parties, the effects being seen in the medical community are dramatic. We have seen a significant increase in the number of hospital admissions for alcohol withdrawal, complications of alcoholic cirrhosis such as bleeding, confusion and ascites, and acute alcoholic hepatitis. Of these conditions, alcoholic hepatitis is the most worrisome as it is acute and associated with a poor prognosis. In a sub-segment of people with this condition, survival is less than fifty-fifty, and patients progress to liver failure, bleeding and death.
Mostly, these young patients are not candidates for liver transplantation when they initially come to the hospital. Alcoholic hepatitis occurs in about 20 percent of heavy drinkers and occurs in people with significant underlying liver scarring. Therefore, having alcoholic hepatitis means that the person has significant underlying liver disease and is in trouble. Sadly, there appears to be a trend that these admissions are being seen in young people, predominantly men, in their late 20s and early 30s. Many of these young people are being seriously ill and may not survive. We are also seeing an increase in outpatient referrals for abnormal liver tests and functions related to alcohol use. Remember, alcohol use also leads to weight gain. Many of these referrals are in high schoolers and young adults.
The acute effects of alcohol on the liver can be quite serious. Alcohol intoxication can lead to acute liver failure and death. Persistent alcohol use can rapidly lead to alcoholic fatty liver, hepatic inflammation and liver fibrosis, which can take years to reverse. The only treatment is a complete cessation of alcohol intake.
Alcohol is used by many to help cope with stress. The past few months have placed all of us under previously unseen levels of stress. We all are looking for ways to cope. Alcohol is also used to help with relaxation and increase social interactions, whether in person or virtual.
Hopefully, in the not too distant future, the COVID nightmare will come to an end and we will be able to resume a more normal way of life. Until then, it is incumbent on people practicing social distancing to watch what they eat, continue to exercise and hone and limit alcohol intake. In moderation, alcohol use can be safe. In excess, it can be dangerous and life-threatening.
