by Brenda Keller, CNP, Gastroenterology Associates of Northwest Ohio
One of the common responses to a diagnosis of cirrhosis, the late stage of progressive liver damage, is “How much does she/he drink?” It is known that excessive alcohol consumption can be associated with cirrhosis. However, there are several causes outside of alcohol consumption.
Cirrhosis can be called “end-stage liver disease.” Damage to the liver causes scar tissue that replaces normal liver tissue. When the damage occurs, the liver can no longer function properly. Typically, the disease progresses slowly, often over the course of several years. In advanced stages, cirrhosis is considered irreversible with liver transplantation as the only treatment option.
There are numerous causes of liver disease that can result in cirrhosis. The most common causes of cirrhosis in the United States account for approximately 80 percent of patients on transplant waiting lists and are as follows:
- Chronic viral hepatitis (such as hepatitis B or C): Hepatitis B is a virus that can cause acute and chronic infection. Chronic hepatitis develops in about 15 percent of adults who are unable to eliminate the hepatitis B virus after an initial infection. The virus is transmitted through blood and body fluids. Blood contact can occur by sharing syringes during IV drug use, sharing razors, receiving unsanitary tattoos or by touching wounds on an infected person. A vaccine series is available to prevent hepatitis B infection. Hepatitis C is also transmitted through blood and body fluids and usually leads to chronic hepatitis, resulting in cirrhosis. Patients with hepatitis C are susceptible to severe infection if they contract either hepatitis A or hepatitis B, so all persons with hepatitis C should be immunized against hepatitis A and B if they are not already immune. They should also avoid alcohol. Antiviral medications can sometimes effectively reduce the virus to undetectable levels. The genotype of the virus is a determining factor in how effective the medication will be in treating hepatitis C. Genotype 1 is the most resistant strain.
- Alcoholic liver disease: 80 percent of alcohol passes through the liver to be detoxified. Chronic consumption of alcohol contributes to the development of inflammation and eventually fibrosis of liver cells. Fibrosis is essentially scar tissue in the liver and occurs when the liver attempts to repair and replace damaged cells.
- Non-alcoholic liver disease (NAFLD): NAFLD is the build-up of extra fat in the liver cells. The liver normally contains some fat, but if more than 5 to 10 percent of the liver’s weight is fat, it is considered a fatty liver (steatosis). NAFLD affects an estimated 25 percent of the population. Insulin resistance appears to be the strongest risk factor, although NAFLD can occur without a person being insulin resistant. Other risk factors include obesity, high blood sugar and high levels of fats, particularly triglycerides in the blood.
- Hemochromatosis: Hemochromatosis is a disease in which too much iron builds up in the body (iron overload), which can lead to cirrhosis. There are two types of hemochromatosis: primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron is absorbed from food. Secondary hemochromatosis is usually a result of another condition that causes iron overload. Treatment of hemochromatosis is aimed at reducing the amount of iron in the body to normal levels. This is often done through therapeutic phlebotomy or blood donation.
- Autoimmune hepatitis (AIH): AIH is the inflammation of the liver that occurs when the immune system attacks the liver. The exact cause of AIH is unclear, but genetic and environmental factors appear to interact over time, leading to the condition. Untreated AIH can lead to cirrhosis. Type 1 AIH is the most common type of the disease, and approximately half of individuals with Type 1 AIH have other autoimmune disorders such as celiac disease, rheumatoid arthritis or ulcerative colitis. The condition is more common in females. The goal of AIH treatment is to slow or stop the immune system’s attack on the liver, and the initial treatment is usually Prednisone.
These are just a few of the many conditions that can contribute to the development of cirrhosis. As you can see, a person with cirrhosis may not have consumed any alcohol and still developed the condition. For more information about cirrhosis, contact your local gastroenterologist.