Cirrhosis is the pathological replacement of functional liver tissue with scarred, fibrous, dysfunctional tissue, which can affect many of the liver’s metabolic processes and present a serious health threat. Most forms of late-stage chronic liver disease often exhibit cirrhosis.
Integrative interventions like silymarin, vitamin E, and S-adenosylmethionine (SAMe) can be helpful in protecting liver cells and improving survival rates.
Complications of Cirrhosis
- Ascites, an increase in free fluid in the abdomen, is the most common complication of cirrhosis
- Portal hypertension (high blood pressure in the liver) can lead to consequences for kidney, lung, gastrointestinal, and cardiovascular function
- Gastroesophageal varices, which are abnormal, enlarged veins in the lower part of the esophagus or stomach that can rupture and hemorrhage
- Liver cancer
- Hepatic encephalopathy occurs when the dysfunctional liver can no longer metabolize toxins, which build up in the brain, causing cognitive dysfunction, memory problems, mood changes, poor decision making, or delirium; coma and death are possible in severe cases.
Causes and Risk Factors
- Chronic viral hepatitis is the most common cause, usually either hepatitis B or hepatitis C
- Alcoholic liver disease is the second major contributor to cirrhosis incidence in the United States
- Non-alcoholic fatty liver disease and its more severe form, nonalcoholic steatohepatitis, are common causes of cirrhosis and are highly associated with obesity and metabolic syndrome
Note: Proper management and treatment of existing liver disease improves outcomes and may lead to regression of liver fibrosis in some cases.
Diagnosis is based on signs and symptoms (which can sometimes take years to show up) and clinical testing.
Signs and symptoms include:
- Fatigue/weakness, loss of appetite, weight loss, nausea, abdominal pain, and pruritus (itching)
- Enlarged spleen when palpated
- Distended abdomen from ascites
- Jaundice (yellowing of the skin and whites of the eyes)
- Bruising or excessive bleeding
- Dark stools resulting from blood in the feces, or pale-colored stools from lack of bile secretion
- Biochemical tests for compounds released by damaged hepatocytes, including alanine transaminase and aspartate transaminase
- Diagnostic imaging including ultrasound
- Liver biopsy, which is the gold standard for assessing the extent of liver damage
- Prevent progression of the underlying chronic liver disease and manage complications of cirrhosis
- Liver transplantation surgery is the standard treatment for end-stage cirrhosis
Novel and Emerging Therapies
These therapies mostly target the pathways that initiate the liver damage, including:
- PPAR activators, which inhibit liver fibrosis
- Ursodeoxycholic acid, approved for treatment of primary biliary cirrhosis
- Metformin, an anti-diabetic drug that may increase survival time in diabetics with cirrhosis
Dietary and Lifestyle Management
- Abstain from alcohol use and avoid smoking
- Under physician supervision, adjust prescription drug doses as cirrhosis alters liver metabolism of many drugs
- Coffee consumption has been associated with a lower incidence of cirrhosis and may reduce the risk of liver damage
- Milk thistle/silymarin: Milk thistle and its principal flavonoid mixture silymarin have shown remarkable protective and antioxidant effects against several types of liver damage, including cirrhosis.
- Branched-chain amino acids (BCAAs): A systematic review on the use of BCAAs for symptoms of hepatic encephalopathy, a complication of cirrhosis, demonstrated a clear benefit in reducing manifestations of the disease. The effect was independent of the cause of cirrhosis (alcoholic or viral).
- Vitamin D: In a study of subjects with alcoholic liver disease compared with controls, severe vitamin D deficiency was significantly associated with higher liver enzymes, increased liver venous pressure gradient, and worse Model for End-Stage Liver Disease (MELD) scores. Low vitamin D was also associated with cirrhosis and mortality after one year.
- Vitamin E: A study on prospective liver transplantation recipients showed that oral tocotrienols lowered MELD scores (higher scores predict a worse outcome) in 50% of recipients and supplementation with alpha-tocopherol lowered them in 20%.
- S-adenosylmethionine (SAMe): In a large clinical trial of patients with alcoholic cirrhosis on SAMe, those with mild-to-moderate disease were found to have significantly improved survival and significantly reduced progression to liver transplantation in the SAMe group (88%) versus the control group (71%).