Cirrhosis is a disease characterized by the gradual replacement of healthy liver tissue by nodules and fibrous tissue (fibrosis) that gradually impair liver function. It is a serious and progressive disease.
Cirrhosis most often results from chronic liver damage, for example due to excessive alcohol consumption or infection with a virus (hepatitis B or C).
This persistent inflammation or damage, which causes little or no symptoms for a long time, ultimately results in irreversible cirrhosis, which destroys liver cells. In fact, cirrhosis is the late stage of some chronic liver disease.
Who is affected?
In the United States, 1 in 400 adults suffer from cirrhosis according to the National Institutes of Health.
The global prevalence of the disease is not known, but it hovers around the same figures in North America and Western countries. It is even more common in Africa and Asia, where hepatitis B and C are widespread and often poorly managed diseases.
The diagnosis occurs on average between 50 and 55 years.
Symptoms of cirrhosis
When the cirrhosis is advanced enough to cause symptoms, these usually include:
- severe fatigue, loss of appetite and weight loss which are often the first signs
- nausea and diarrhea
- an increase in the volume of the abdomen due to the accumulation of fluid (ascites)
- fluid build-up in the legs causing swelling
- gastrointestinal bleeding, caused by portal hypertension (this is an emergency that requires immediate hospitalization). It results in vomiting blood or very black stools (containing blood).
- bruises (= bruises) or easy bleeding
- itching (pruritus)
- jaundice (jaundice) which may be associated with the above symptoms.
To confirm the diagnosis of cirrhosis, a liver biopsy should be taken to visualize the characteristic fibrous lesions.
People at risk of cirrhosis
As the causes of cirrhosis are diverse, people at risk belong to different groups:
- men over 50 are generally more affected by chronic hepatitis C and alcoholic cirrhosis;
- people with a metabolic syndrome, which combines overweight or obesity, insulin resistance or type 2 diabetes, high blood pressure and hyperlipidemia, are at risk of developing “non-alcoholic fatty liver”.
Risk factors for cirrhosis
- Several preventable risk factors are associated with cirrhosis, in particular:
- Chronic and excessive alcohol consumption. It is the main preventable risk factor for cirrhosis. However, other factors come into play in the development of the disease: only 10 to 15% of alcoholics have liver disease.
- Being infected with a hepatitis virus (B or C) is also a major risk factor for cirrhosis of the liver.
Prevention of cirrhosis
To prevent cirrhosis, it is possible to act on certain preventable risk factors, namely:
- Limit your alcohol consumption to 2 glasses per day for women (less than 30 g / d) and 3 glasses for men (less than 40 g / d);
- Prevent viral hepatitis B through systematic vaccination and appropriate medical care in the event of accidental contamination;
- Use single-use equipment (especially syringes) and adopt protective measures against sexually transmitted infections (condoms) to prevent viral hepatitis B and C.
Once cirrhosis is declared, certain lifestyle and dietary measures can help limit the occurrence of complications or at least slow the progression of the disease:
- Stop drinking alcohol
- Give major importance to oral and skin hygiene (to reduce the risk of infections)
- Adopt a balanced diet low in salt
- In case of excess weight, weight loss is advised, as well as lowering blood sugar and blood lipid levels if necessary
- The practice of regular and adapted physical activity is encouraged.
Treatment of cirrhosis
Cirrhosis is an irreversible disease, for which there is no really effective treatment (other than liver transplantation).
The cause of the cirrhosis must first be treated and the aggravating factors limited:
- In the event of so-called alcoholic cirrhosis, weaning is essential.
- In the event of cirrhosis associated with metabolic syndrome, it is necessary to lose weight, to control the diabetes with well-followed treatment and to lower the level of lipids in the blood.
- In the case of viral hepatitis, antiviral treatments should be given.
More generally, experts emphasizes the importance of:
- Preventing and treat the complications of cirrhosis (digestive hemorrhage, bacterial infections, hepatocellular carcinoma, etc.)
- Updating your vaccinations (hepatitis A, hepatitis B, flu, pneumococcus)
- Adopting hygiene and dietetic measures (in particular oral care)
In the event of cirrhosis, it is urgent to stop the addictive behaviors involved or associated with the disease. In particular, it is important to:
- Stop drinking alcohol, regardless of the cause of the cirrhosis. In people suffering from alcohol dependence, several support measures exist and must be put in place (support groups, detoxification clinic, pharmacological treatments, etc.).
- Stop smoking as it worsens the disease. Nicotine substitutes can be used, as well as a drug withdrawal aid.
- Stop taking medications and drugs that can have a toxic effect on the liver. In particular, you should avoid taking drugs that are metabolized by the liver (you doctor or pharmacist will be able to advise you).
- In case of ascites (accumulation of fluid in the abdomen), the doctor may advise taking diuretic drugs to eliminate water and a diet low in salt. Punctures are sometimes necessary to evacuate the liquid.
Management of hepatitis
If cirrhosis is associated with chronic hepatitis, it is necessary to treat the hepatitis:
- by antiviral treatment with interferon α and/or lamivudine in the event of post-hepatitis B cirrhosis
- by interferon α in the event of post-hepatitis C cirrhosis (possibly combined with ribavirin). New, more effective treatments for hepatitis C (current drugs only cure 50% of those affected) are in development.
If there is an underlying active autoimmune disease, treatment with corticosteroids or immunosuppressive drugs (azathioprine) should be started quickly.
If the cirrhosis is advanced and threatens the life of the affected person, the only possible treatment is a liver transplant.
This operation is risky, however, and organ waiting times are long, at least 1 to 2 in North America.
Cirrhosis is a serious and progressive disease, and its diagnosis inevitably has psychological repercussions. If they deem it necessary, the person with cirrhosis should therefore be able to benefit from psychological support.
Cirrhosis and chronic hepatitis are serious illnesses that require urgent, long-term medical treatment. Be aware that some natural health products can have harmful effects on an already damaged liver. It is therefore important to be well informed before starting a natural or complementary treatment.
Curcumin. Several studies have shown that curcumin (from turmeric) has a beneficial effect on the liver by preventing the build-up of fatty acids in liver cells, which is involved in non-alcoholic fatty liver disease (“fatty liver”). It is traditionally used against liver disease and some studies have shown it to have anti-inflammatory, antioxidant, antimicrobial and anti-tumor properties.
In particular, it appears that curcumin alleviates liver damage associated with alcohol, iron overload and certain poisonings; it also seems to have a beneficial effect on cirrhosis lesions, but the lack of studies prevents establishing recommendations for use.
Silymarin (silibinin). In the event of chronic liver disease linked to alcohol, metabolic syndrome or the toxicity of certain medications or drugs, milk thistle extract or silymarin (Silybum marianum) has a recognized protective and anti-oxidant action. The main active ingredient, called silibinin, has a positive effect on the regeneration and protection of liver cells and several clinical trials have shown that long-term administration of silymarin increases the survival of patients with cirrhosis. induced by alcohol.
Panax notoginseng. Panax notoginseng is a Korean herbal medicine that has been shown to be effective in vitro and in small clinical trials conducted in Asia on the protection of liver function, especially in cirrhosis.