What is cirrhosis? Can it be cured or prevented by abstaining from alcohol?
Cirrhosis can be the outcome of many different liver diseases, although in this country, alcoholism and chronic infection with hepatitis viruses B and C are the most common causes.
Cirrhosis is defined as extensive scarring of the liver, with areas where liver cells have died and nodules of liver tissue have grown back. Strictly speaking, a diagnosis of cirrhosis can be made only with a liver biopsy. In practice, however, a physician may diagnose cirrhosis if the person has had a condition known to produce cirrhosis and shows abnormal results in blood tests which measure liver function.
Cirrhosis is almost always the final stage of a process that has taken many years to develop. It is estimated that 10 years of heavy drinking are necessary to cause alcoholic cirrhosis; similar lag times are seen after infection with hepatitis B or C. In all these cases, cirrhosis is the result of many repeated episodes of hepatitis, or low grade continuous hepatitis, during which liver cells die, areas of inflammation develop, and scarring appears in and around the inflamed areas. During much of that time, the person will have no symptoms, and will assume that he or she has no problem. Of course, this can be a very damaging conclusion for an alcoholic who may then continue to drink, causing even more liver damage.
In the case of alcoholic liver disease, there is a preliminary stage when liver cells have not started to die, and scarring is absent. If one stops drinking at this point, cirrhosis can usually be prevented.
Once cirrhosis has developed, scarring is irreversible, although treating the underlying cause may still prolong life. Alcoholics with cirrhosis who abstain totally from drinking do much better and live longer than those who continue to drink. Treatment of hepatitis B with interferon and lamivudine and hepatitis C with interferon and ribavirin may also prevent the progression of cirrhosis, although such treatment may be difficult due to the liver damage already present.
Cirrhosis of the liver can also follow primary biliary cirrhosis, an autoimmune disease seen mostly in women; hemochromatosis, a disorder of iron metabolism, seen earlier and more severely in men than in women; Wilson’s disease, a disorder of copper metabolism; and a few even rarer conditions.
Regardless of the original cause of the cirrhosis, once present, it can lead to numerous complications such as varicose veins in the esophagus and abnormal fluid build up (edema) in the abdominal cavity. If the number of functioning liver cells falls below a certain amount, the liver will not be able to carry out necessary metabolic functions, and liver failure will set in. At this stage, the only treatment is liver transplantation.
In 10-15% of people with cirrhosis, liver cancer may develop. Liver cancer is common in much of Asia, where hepatitis B and C have been common for many generations, and it is becoming much more common in this country, with the large increase in cases of hepatitis C seen over the last few decades.