Alcohol-related cirrhosis: is it reversible?

Cirrhosis is the late stage of alcohol-related liver disease in which the liver becomes significantly scarred from long-term alcohol use.As well as the liver, excessive alcohol consumption can damage many other parts of the body, leading to chronic diseases and other serious problems. Once a person stops drinking and their condition improves, however, many of their complications, fortunately, can often be managed. There’s just one question that still lingers: can liver damage ever be reversed? Professor Shahid A Khan, a top consultant physician based in London, explains.

What is alcohol-related cirrhosis?

Alcohol-related cirrhosis is caused by excessive or long-term alcohol intake. Cirrhosis is a term to describe the scarring of the liver. Scarring of any tissue in the body is called fibrosis and there are various grades of severity, from 0-4. Cirrhosis is in grade 4.

There can be many possible causes of cirrhosis, but excessive alcohol consumption is one the most common in the western world. Scarring can occur over 10, 20 or 30 years and depends on how much the person drinks, their genetic makeup, gender, fitness level and other medical health issues.
 

What are the main treatments for alcohol-related cirrhosis?

The main treatment is to stop the underlying cause, which in this case would be to stop drinking alcohol, preferably for the rest of your life. There is no particular drug that can directly reverse alcohol-related cirrhosis. However, there are treatments for some of the complications that arise from this condition. By stopping drinking completely you are reducing the risk of further damage to your liver and gives it a chance to recover.
 

Is the damage from alcohol-related cirrhosis ever reversible?

Yes, your liver can recover, but it depends on the extent of the liver damage. To measure it, we use the Child-Pugh scoring system which categorises the liver function from classes A to C.
 

• Class A - the very early stage of liver scarring, where the liver is working normally and the patient may not even be aware of it.

• Class B - as the cirrhosis advances, it causes mild to moderate liver damage and the patient may start noticing symptoms such as jaundice, fluid in the abdomen and brain fog (confusion, also called encephalopathy).

• Class C - there is severe liver damage and the patient will become very sick. The liver during this stage stops working properly.

If the patient falls into classes A and B, they can likely reverse the liver damage by stopping drinking and maintaining a healthy lifestyle. If they fall into class C, however, they can also recover, but it isn’t certain.
 

We have seen patients recover from class C liver damage in the past so it is possible. Your best chance of achieving this by stopping drinking completely.
 

How can a doctor manage the associated complications?

As the cirrhosis progresses, you may notice complications occurring. While there aren't medications to treat cirrhosis directly, fortunately, there are ways to treat the complications that can arise.

Ascites

Fluid can build up in the abdomen and around the intestines. This fluid retention is treatable with diuretic tablets. Sometimes, many litres of fluid can build up which will then need to be drained using a procedure known as paracentesis.

Encephalopathy

The main function of your liver is to remove toxins from your body. If your liver isn’t working properly it can’t remove these toxins from the blood so they build up to high levels. This causes confusion (brain fog), agitation, disorientation, muscle stiffness and tremors, difficulty speaking and in serious cases, coma. Laxatives can be used to help treat this to bring about regular bowel output. Rifactamin can also be given, which is a special antibiotic to reduce toxins in the gut.

Bleeding and clotting

Patients with cirrhosis are at an increased risk for both bleeding and thrombosis. A combination of medications and dietary changes such as a high protein diet can help treat this.

Liver cancer

Cirrhosis is the main risk factor for primary liver cancer. If patients have cirrhosis, they increase their risk of developing liver cancer by two to five per cent every year. We manage this with surveillance, which involves having an ultrasound scan every six months to detect any early developments of tumours. The aim is to pick it up when the tumour is very small so we can treat it more effectively. The smaller the tumour is, the more treatable is it. There are curative options if it is caught early.
 

What additional lifestyle changes are needed to prevent alcohol-related cirrhosis from worsening?

It’s important to have regular checkups with a specialist at least twice a year to look for and manage complications. During your checkups a doctor will look at:

Abstaining from alcohol

It’s not easy to stop drinking, and it’s estimated that around 70 per cent of people with alcohol-related cirrhosis have an alcohol dependency problem. There are self-help groups in your area that can help you to stop drinking. Your doctor will also advise you on what you should do and may refer you to get psychological support.

Maintaining a good diet

It is important to ensure you are fit and healthy and your body is getting all the right nutrients it needs. Malnutrition is common in people with alcohol-related cirrhosis. Your doctor will refer you to a dietician for advice. A good diet will include one high in protein and fresh fruit and vegetables.

Managing any other illnesses

Going for regular check-ups and taking all medications properly is important to identify illness and complications and treat them effectively.

Maintaining a healthy BMI and losing weight

This can be achieved by eating a good diet and making sure you are staying active and exercising regularly.
 

How do I know if my cirrhosis is worsening and how can I prevent it?

The best way to prevent cirrhosis from worsening is to get regular check-ups with a specialist, which often involves getting scans every six months.
 

Years ago, a liver biopsy was needed to measure how scarred your liver was, however, there is now a simpler way to assess this, by using a Fibroscan. This is a special ultrasound scan that takes 5 - 10 minutes to complete and provides us with an immediate result there and then.
 

A Fibroscan is effective and painless, and can also be tailored to patients who are clinically well but are worried about their liver and want to check it is in good health.
 

The London Liver Group offers Fibroscan packages. To enquire about the packages we offer, visit The London Clinic's website.

Professor Shahid A Khan is a leading consultant physician based at The London Clinic and several other locations in London. Head to his Top Doctors profile to book an appointment with him.