Cirrhosis Treatment: Current Approaches and Future Horizons
Managing cirrhosis, a late stage of scarring of the liver, centers on addressing the underlying cause and preventing further damage. As Lindenmeyer explains, the initial step is always to eliminate the ‘insult’ to the liver. So treating autoimmune hepatitis with appropriate medications, complete alcohol abstinence for alcohol-related liver disease, and managing metabolic risk factors like obesity or diabetes in cases of Metabolic dysfunction-associated steatohepatitis (MASLD).
Targeting the Root Cause
Regardless of the initial trigger, avoiding further liver harm is paramount. Patients with hepatitis-related cirrhosis, for example, should also abstain from alcohol. The overarching goal is to halt disease progression and prevent liver failure.
New Pharmaceutical Interventions
In March 2024, the FDA approved rezdiffra (resmetirom), the first drug specifically designed to treat liver scarring caused by metabolic associated steatohepatitis (MASH). This medication works by activating a thyroid hormone receptor in the liver, reducing fat accumulation and is intended to be used alongside lifestyle changes like diet and exercise.
Managing Complications with Medication
Beyond addressing the primary cause, medications are crucial for managing cirrhosis complications. Lactulose, a laxative, can facilitate combat hepatic encephalopathy – confusion resulting from toxins in the brain. Diuretics, or water pills, reduce fluid buildup in the abdomen (ascites). Antibiotics, such as rifaximin, are used to prevent or treat infections and can also aid in managing hepatic encephalopathy, often in conjunction with lactulose.
Blood pressure medications, specifically beta-blockers, can lower pressure in the portal vein, reducing the risk of internal bleeding. For those experiencing itching, cholestyramine or colesevelam (also used for high cholesterol) may provide relief. In some cases, rifampin or naltrexone might be considered, but these require careful monitoring due to potential liver-related side effects.
Liver Transplantation: A Lifesaving Option
When medical management is no longer sufficient, liver transplantation remains a vital treatment option. This involves replacing a diseased liver with a healthy one from a deceased or living donor. However, the demand for organs significantly outweighs the supply.
The Role of Complementary Therapies: Proceed with Caution
Many supplements claim to support liver health, but most lack scientific backing and some contain harmful ingredients. Clinical trials generally haven’t demonstrated their effectiveness. Currently, there isn’t enough evidence to recommend any herbal products for cirrhosis. It’s crucial to inform your doctor about any supplements you’re taking or considering, as some can be toxic to the liver. Cleanses and detox regimens are also not recommended.
The Growing Concern of MASLD and Cancer Risk
Recent research highlights the link between fatty liver disease – now categorized as MASLD and MASH – and an increased risk of cancer. This underscores the importance of early diagnosis and intervention.
‘Forever Chemicals’ and Liver Health
Emerging studies suggest a potential connection between exposure to ‘forever chemicals’ and an increased risk of liver disease, particularly in adolescents, with risks increasing by as much as threefold.
Global Variations in Fatty Liver Disease
The prevalence of fatty liver disease varies significantly across the globe, with differences observed even when using different diagnostic criteria (NAFLD, MAFLD, and MASLD). Studies in large populations, such as those conducted in Iran, demonstrate these variations.
FAQ
What is the first step in treating cirrhosis? Identifying and eliminating the underlying cause of the liver damage.
What is rezdiffra used for? Rezdiffra is the first FDA-approved drug to treat liver scarring caused by metabolic associated steatohepatitis (MASH).
Are liver cleanses safe for someone with cirrhosis? No, cleanses and detox regimens are not recommended and can potentially be harmful.
What is the main treatment for advanced cirrhosis? Liver transplantation is often the only remaining option when medication can no longer control complications.
Is there a link between fatty liver disease and cancer? Yes, recent research indicates an increased cancer risk associated with MASLD and MASH.
Pro Tip: Lifestyle changes, including a healthy diet and regular exercise, are crucial components of managing cirrhosis, regardless of the underlying cause.
Did you know? The FDA approved the first drug to treat liver scarring caused by MASH in March 2024, marking a significant advancement in cirrhosis treatment.
Want to learn more about liver health? Explore our other articles on managing liver disease and preventative care. Subscribe to our newsletter for the latest updates and expert advice!
