What is cirrhosis?

From the Guidelines

Cirrhosis is a late-stage liver disease characterized by extensive scarring (fibrosis) of the liver tissue, which disrupts normal liver function and structure, and is typically caused by chronic conditions such as alcoholism, viral hepatitis, nonalcoholic fatty liver disease, and certain autoimmune disorders.

Definition and Causes

Cirrhosis occurs when healthy liver cells are damaged and replaced by scar tissue over time, preventing the liver from performing its vital functions, including filtering toxins from the blood, producing proteins for blood clotting, and processing nutrients 1. The disease develops gradually, often over years or decades, and can lead to serious complications including portal hypertension, fluid accumulation in the abdomen (ascites), bleeding varices, hepatic encephalopathy, and liver cancer 1. Some key factors that contribute to the development of cirrhosis include:

• Chronic alcohol consumption
• Viral hepatitis (particularly hepatitis B and C)
• Nonalcoholic fatty liver disease
• Certain autoimmune disorders

Stages and Complications

Cirrhosis consists of three distinct prognostic stages:

• The compensated stage, which is defined by the absence of clinically overt complications and is associated with a median survival that exceeds 12 years
• The stage of decompensation, which is marked by the development of ascites, hepatic encephalopathy, and/or gastroesophageal variceal hemorrhage and is associated with a median survival of approximately 2 years 1
• A third stage of “further” decompensation, which is characterized by the development of a second (additional) decompensating event, recurrent ascites, recurrent variceal hemorrhage, recurrent hepatic encephalopathy, spontaneous bacterial peritonitis, acute kidney injury, and/or jaundice As the disease progresses, it can lead to serious complications, including:
• Portal hypertension
• Fluid accumulation in the abdomen (ascites)
• Bleeding varices
• Hepatic encephalopathy
• Liver cancer While early cirrhosis may not cause noticeable symptoms, advanced cirrhosis can manifest as fatigue, easy bruising, jaundice, itchy skin, swelling in the legs and abdomen, and mental confusion 1.

Treatment and Management

Although the liver damage from cirrhosis cannot be reversed, treatment focuses on stopping further progression by addressing the underlying cause and managing complications to improve quality of life and prevent liver failure 1. Dietary modifications, such as a Mediterranean-style diet rich in vegetables, whole grains, fruits, seafood, and olive oil, may be essential for both cirrhosis prevention and treatment. Some key aspects of cirrhosis management include:

• Addressing the underlying cause of the disease
• Managing complications, such as ascites and variceal hemorrhage
• Improving liver function and reducing the risk of abnormalities
• Preventing liver failure and improving quality of life

From the Research

Definition of Cirrhosis

• Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury, which leads to portal hypertension and end-stage liver disease 2.
• It is characterized by pathologic scarring of liver tissue that leads to impaired liver function 3.
• Cirrhosis can result from any etiology of chronic liver inflammation and causes significant disease burden 3.

Causes and Prevalence of Cirrhosis

• The most common causes of cirrhosis include alcohol use disorder, nonalcoholic fatty liver disease, and hepatitis C 4.
• Cirrhosis affects approximately 2.2 million adults in the US, with an annual age-adjusted mortality rate of 21.9 per 100,000 people 4.
• The prevalence of cirrhosis is increasing, with a significant increase in mortality rates from 2010 to 2021 4.

Diagnosis and Management of Cirrhosis

• Cirrhosis can be diagnosed by liver biopsy, but noninvasive tests such as elastography and imaging studies (e.g., ultrasonography, transient elastography) are also used 3, 4.
• Management of cirrhosis involves treating the underlying cause, such as alcohol use disorder or nonalcoholic fatty liver disease, and preventing complications such as variceal bleeding and hepatic encephalopathy 3, 4.
• Nonselective beta-blockers, lactulose, and combination aldosterone antagonists and loop diuretics are commonly used to manage cirrhosis and its complications 4.

Complications of Cirrhosis

• Cirrhosis can lead to various complications, including ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma 3, 4.
• The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively 4.
• Spontaneous bacterial peritonitis and hepatorenal syndrome are also common complications of cirrhosis, with high mortality rates 4.

Reversibility of Cirrhosis

• Early stages of liver fibrosis are reversible, and management of underlying diseases can halt the progression and even reverse liver fibrosis 5.
• However, advanced stages of cirrhosis are often irreversible, and liver transplantation remains the only curative option for a selected group of patients 2.