Treatment for cirrhosis – NHS

The treatment for cirrhosis depends on what has caused it. Cirrhosis cannot usually be cured, but there are ways to manage the symptoms and any complications, and stop the condition getting worse.

Lifestyle changes

If you have cirrhosis, there are several lifestyle changes you can make to reduce your chances of further problems and complications. These include:

• avoid alcohol 
• quit smoking
• lose weight if you’re overweight or obese
• do regular exercise to reduce muscle loss
• practise good hygiene to reduce your chance of getting infections
• speak to a GP about vaccinations you may need, such as the annual flu vaccine or travel vaccines
• speak to a GP or pharmacist if you’re taking over-the-counter or prescription medicines, because cirrhosis can affect the way some medicines work

Dietary changes

Malnutrition is common in people with cirrhosis, so it’s important you eat a healthy, balanced diet to help you get all the nutrients you need.

Cutting down on salt can help reduce the chance of swelling in your legs, feet and tummy caused by a build-up of fluid.

The damage to your liver can mean it’s unable to store glycogen, which is a type of fuel the body needs for energy.

When this happens, your muscle tissue is used for energy between meals, which leads to muscle loss and weakness. This means you may need extra calories and protein in your diet.

Eating healthy snacks between meals, or having 3 or 4 small meals each day, rather than 1 or 2 large meals, may help.

Medicine

The medicine you need will depend on what caused the damage to your liver. For example, if cirrhosis is from long-term viral hepatitis, you may be prescribed antiviral medicine.

You may be offered medicines to ease the symptoms of cirrhosis, such as:

• diuretics, which are used in combination with a low-salt diet to reduce the amount of fluid in your body, which helps with swelling (oedema)
• medicine to help with high blood pressure in the main vein that takes blood to the liver (portal hypertension)
• prescription creams to ease skin itching

Managing complications

If cirrhosis progresses and your liver is no longer able to function (decompensated cirrhosis), you may get complications that need treatment.

Swollen or bleeding veins

When cirrhosis has progressed, it can cause the veins in your food pipe (oesophagus) or stomach to become swollen. These are called oesophageal varices and gastric varices.

An endoscopy is used to diagnose oesophageal and gastric varices.

You may be given a type of medicine called a beta blocker, such as propranolol, to reduce the chance of the varices bleeding, or to help control bleeding.

If you vomit blood, or have blood in your poo, it may be because the varices are bleeding (a variceal haemorrhage). You will need urgent treatment. Go to your nearest A&E department immediately.

There are several treatments used to prevent or stop the bleeding, such as medicines and fitting a band around the veins (endoscopic variceal band ligation).

Find out more about the treatments for oesophageal and gastric varices from The British Liver Trust.

Fluid in the tummy and legs

A build-up of fluid in your tummy area (ascites) or legs and ankles (peripheral oedema) is a common complication when cirrhosis progresses.

The main treatments are cutting out salt from your diet and taking a type of medicine called a diuretic, such as spironolactone or furosemide.

If the fluid in your tummy becomes infected, you may need antibiotics. In severe cases, you may need to have the fluid drained from your tummy area with a tube.

Encephalopathy

Cirrhosis can sometimes cause problems with your brain function (encephalopathy).

Symptoms include confusion, feeling sleepy, and problems concentrating. This happens because the liver is no longer able to clear toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative and helps clear toxins from your body. You may also need to take an antibiotic called rifaximin, to prevent infection.

Bleeding

Cirrhosis can affect your liver’s ability to make your blood clot, which means there’s a chance of severe bleeding if you cut yourself or have an operation or dental work.

You may be given medicines, or a blood product called plasma, to prevent or treat bleeding.

Talk to your doctor about your condition and the risk of bleeding before having an operation, including any dental work.

Liver transplant

If cirrhosis progresses and your liver is severely damaged, a liver transplant may be the only treatment option.

This is a major operation that involves removing your diseased liver and replacing it with a healthy liver from a donor.

You will probably have to wait a long time for a suitable donor liver to become available.

You will not be able to have a liver transplant if cirrhosis was caused by alcohol-related liver disease and you continue to drink alcohol.

Find out more about a liver transplant from the British Liver Trust.

Diabetes

Diabetes may get worse if you have type 2 diabetes and develop cirrhosis.

This is because cirrhosis can increase your resistance to insulin, a hormone produced by the body to control blood sugar levels.

Managing cirrhosis and diabetes can be very challenging. You will need careful monitoring and may need to take several different medicines.

Liver cancer

Having cirrhosis increases the chance of liver cancer, most commonly a type called hepatocellular carcinoma (HCC).

Many symptoms of liver cancer are the same as symptoms of cirrhosis, so regular checks for liver cancer are important.

You should have an ultrasound scan, and may also have blood tests, every 6 months to check for HCC.

Read more about liver cancer.

Page last reviewed: 29 June 2020
Next review due: 29 June 2023

Leveraging the liver’s ability to heal scarred tissue

In medical school, Cliff Brass was interested in the brain. He and a friend, who favored the liver, used to argue about which organ was smarter. They are both hepatologists now.

“I guess that answers that question”, says Brass, Senior Global Program Medical Director at Novartis Pharmaceuticals. “The liver is an amazing organ”.

For instance, it is possible to take a hunk of one person’s liver and transplant it into another person. The partial organ will grow to fit the space available, suggesting that the liver has unusual regenerative capabilities.

It is one thing for a healthy liver to have such powers, but can a scarred liver heal itself? For a long time, the answer was quick and clear: No.

“Despite the fact that evidence of the reversibility of liver scarring started accumulating in the 1960s, the prevailing wisdom was that once you get scar tissue in the liver, it’s permanent”, says Chinwe Ukomadu, a hepatologist and Senior Translational Medicine Specialist at the Novartis Institutes for BioMedical Research.

Only recently have scientists and liver specialists begun to change their answer to a qualified yes. Yes, it’s reversible, but it isn’t clear how. This shift in thinking has opened the door to the idea that medicine may be able to speed up the process. Scarring occurs in many liver diseases and is ultimately the cause of liver failure in late stages of disease, so healing scarred liver tissue would benefit most liver disease patients. For instance, Novartis has recently begun clinical testing of a new investigational compound that might have anti-scarring effects.

One of the first clues suggesting that liver scarring might be reversible came out of a hospital in Miami, FL, in 1962. Doctors there were working with a handful of patients with hemochromatosis, a disorder that causes iron to accumulate in the liver and cause scarring. They took biopsies of patients’ livers before and after performing procedures to remove the iron. After the procedure, they found that the amount of scarring had decreased.

Over time, similar hints appeared in other small-scale studies, says Ukomadu. For instance, the life expectancies of recovering alcoholics—who are thought to have extensive liver scarring—are longer than the life expectancies of people who continue to drink. And patients with autoimmune hepatitis who are treated with steroids to reduce liver damaging inflammation have similar life expectancies whether they begin treatment with advanced liver scarring, called cirrhosis, or without.

“In these cases, something is getting better,” says Ukomadu. “But is it the liver? Researchers have argued that it could be anything”.

The real turning point in thinking came with the advent of treatments for viral liver disease. In the 1990s, drugs became available to treat hepatitis C and hepatitis B. When patients took these drugs, they effectively removed the root cause of the organ damage. Later, liver biopsies revealed that many patients, even those with late-stage cirrhosis had recovered.

“In some cases, you couldn’t tell that the patients had been sick,” says Ukomadu. “Their cirrhosis had completely disappeared”.

Today, researchers at Novartis see two possible ways to repair scarred livers. One is to stop the disease process that is causing the damage and wait for tissue to heal.

This approach has merit, but during the time it takes for the liver to repair itself, patients are left in a vulnerable condition. If they experience another illness or hospitalization while living with an incapacitated liver, they may not fare well. In some cases, this vulnerability may be hidden because patients with liver scarring don’t always show symptoms.

“The liver is a biochemical factory for the body, but it’s a factory with a vast overcapacity”, says Brass. “It may not be until someone’s liver is very close to the edge of keeping up that they suddenly see a dramatic downturn in health”.

Currently the only option for patients with end-stage liver disease is a liver transplant. This procedure is only offered in certain parts of the world, and donor tissue is in short supply.
So Novartis favors a more proactive strategy to find ways to directly reverse scarring to give liver disease patients a fighting chance.

“Many patients who are waiting for transplants become miserably sick,” says Ukomadu. “The ability to stall or reverse liver scarring would have enormous impact”.

Main image: This liver tissue from a patient with non-alcoholic fatty liver disease (NASH) shows mild fibrosis (green), which can lead to advanced liver scarring called cirrhosis. Image: Nephron/Wikimedia

A reversal in thinking about the reversibility of liver damage is changing the field of hepatology.

Cirrhosis is curable! – (publication in the journal Ogonyok) – “HEPATIT.RU”

Bella LURIER, Candidate of Biological Sciences, Member of the European Association for the Study of the Liver, Hepatological Research Center GEPATIT.RU (gepatit.ru) at the Medical Center “Clinic on Sadovoy”.

– Any sensational discoveries in science must be confirmed by evidence-based medicine. This means that a new drug must go through several stages of clinical trials in different independent research centers, and these trials must be carried out according to a double-blind method, involving placebo control, and only then can we say that the use of a new drug in such and such a certain percentage cases gives positive results. Before carrying out such full-scale studies, I consider it not only premature, but also dangerous, to talk about some kind of revolutionary discovery.

You see, most people have little idea of ​​the complexity of such diseases as viral hepatitis and cirrhosis. Someone read something on the Internet, others heard something out of the corner of their ear. And I am very afraid that many people with cirrhosis will either wait for this supposedly miraculous drug without taking any serious measures for treatment, or, even worse, will rush to scammers promising miracles of healing. And such cases have already happened – for example, when in Novosibirsk, unknown “professors” invented the “treatment” of viral hepatitis by heating the blood. Many people then suffered, many eventually came to us, where we provided them with real medical care. And someone could no longer be helped because of lost time and improper treatment.

Therefore, I want to responsibly declare to you: if the disease has not crossed the boundaries of irreversible changes, then modern medicine already has the means to treat cirrhosis. There are works published in serious scientific journals that prove that the process of fibrosis in the liver is reversible. However, in order to get the result, it is extremely important to start treatment on time and correctly.

Cirrhosis caused by hepatitis B or hepatitis C viruses can be treated with antiviral drugs such as interferons and nucleoside analogues. This has been proven by serious scientific research and confirmed by practical observations, in particular, in our center.

Cirrhosis of alcoholic etiology can be defeated only by completely abandoning alcohol. Now non-alcoholic liver damage, the so-called metabolic syndrome, is widespread, the treatment of which must be carried out by an endocrinologist, since it is associated with hormonal disorders.

If cirrhosis has passed into an irreversible stage, then the only method of salvation may be a liver transplant, which is still carried out on a limited scale and does not guarantee recovery.

Of course, any treatment for cirrhosis is not a miracle pill. There are no miracles in the world. Liver fibrosis is a very long process, and the recovery process is not lightning fast. But it is important to know that with proper and timely treatment, viral, alcoholic and metabolic cirrhosis can be cured. At least they can be stopped.

Liver cirrhosis due to viral hepatitis is reversible. Treatment of cirrhosis in hepatitis B and C

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Early stages of cirrhosis CAN BE TREATED. Reverse development of cirrhosis is possible!!!.

Formation of cirrhosis of the liver
– This is a long process during which the destruction of the liver occurs and the replacement of normal healthy liver tissue with connective tissue or adipose tissue, depending on the cause of liver damage.

In viral hepatitis and alcoholic cirrhosis, it is a connective tissue, the density of which is much higher than the density of normal healthy hepatic parenchyma. As a result, the structure of the liver changes, its functionality is impaired, blood circulation in the abdominal cavity suffers catastrophically. Due to the increase in pressure in the main vessels of the liver, they expand and eventually rupture with subsequent internal bleeding.

If the cause of cirrhosis is fatty hepatosis, then the same changes are caused by the replacement of liver tissue with fatty tissue.

If viruses are the cause of cirrhosis, then the only way to stop the process, which has not yet reached irreversible stages, is antiviral treatment. Antiviral drugs have antifibrotic and anticirrhotic effects. Prescribing antiviral therapy in such cases is a serious and responsible decision for a doctor, since treatment with these drugs is often accompanied by side effects with quite dangerous blood changes. However, there are NO other ways to survive.

Our doctors have treated a lot of patients with cirrhosis. We have helped many of them. Many patients with the initial stage of cirrhosis, after treatment, are absolutely healthy and have a degree of fibrosis F0!! This is not an easy path. Sometimes two or more courses of antiviral therapy, non-standard solutions, joint efforts of the doctor and the patient made it possible to cope with a serious illness. Unfortunately, this does not always happen.

For the treatment of liver cirrhosis against the background of fatty hepatosis, an endocrinologist is necessarily involved in the treatment, since the cause of liver disorders in this case is hormonal and metabolic changes that can be treated in almost 100% of cases, but with the obligatory implementation by patients of the endocrinologist’s recommendations for changing lifestyle, including including nutrition and physical activity.

You can immediately make an appointment with a hepatologist
for a paid consultation by phone +7 495 255 10 60, but if you have not undergone an examination to clarify the stage of cirrhosis, sign up for a free consultation to schedule such an examination.

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What is important to know

• What is hepatitis B
• Hepatitis B treatment
• What is Hepatitis C
• Hepatitis C treatment
• Treatment of hepatitis C with new drugs
• alcoholic liver disease
• Fatty hepatosis
• Cirrhosis of the liver
• What is liver elastometry (fibroscan)
• Analyzes and examinations

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