Most people associate cirrhosis with heavy drinking, but that’s not all. While alcohol is the leading cause of cirrhosis in the United States, even abstainers can develop the disease. Any scarring of the liver not caused by alcohol is referred to by the general term of non-alcoholic cirrhosis.

What are the causes of non-alcoholic cirrhosis?

One of the jobs of the liver is to remove germs from the blood. Sometimes, however, germs take over. Chronic hepatitis C virus infection is the most common cause of nonalcoholic cirrhosis in the United States. In most cases, it takes several years for the infection to cause scarring. Yet only about 20% of people with chronic hepatitis C develop cirrhosis.

Chronic hepatitis B infections can also lead to cirrhosis. Worldwide, it may be the most common cause of cirrhosis, but it is rare in the United States, where children are routinely vaccinated against hepatitis B. The virus that causes hepatitis A does not never persists long enough to cause cirrhosis.

Another potential starting point for cirrhosis is non-alcoholic steatohepatitis (NASH), a condition in which the liver contains excess fat and becomes inflamed. The cause of NASH is not well understood, but obesity, diabetes, protein malnutrition, heart disease, and corticosteroids all seem to increase the risk.

Some people can trace cirrhosis to an overactive immune system. For unknown reasons, they produce antibodies that attack liver cells as if they were intruders. The liver becomes damaged and inflamed, a condition known as autoimmune hepatitis.

Other rare causes of cirrhosis include blocked or inflamed bile ducts, severe reactions to medications or supplements such as methotrexate or vitamin A, frequent episodes of heart failure, and inherited conditions such as cystic fibrosis, deficiency in alpha-1-antitrypsin, hemochromatosis and Wilson’s disease. sickness.

In up to 10 percent of all cases, no cause for cirrhosis can be found. Doctors call these cases “cryptogenic cirrhosis.” Increasingly, however, researchers theorize that many of these cases are actually caused by NASH.

What are the symptoms of non-alcoholic cirrhosis?

Whether it comes from a virus or a bottle of alcohol, cirrhosis is a potentially debilitating disease. You probably won’t notice any symptoms at first, but as the damage builds up, you’ll feel weak and exhausted. You may also lose your appetite, feel nauseous, and lose weight. Some women suddenly stop menstruating, and men can develop erectile dysfunction, lose sex drive, and have enlarged breasts that are painful.

As healing progresses, your skin and eyes may turn yellow (jaundice). Your skin may also become intensely itchy, a condition called pruritus. The backed up fluids can cause your abdomen to swell (ascites) and internal bleeding can cause you to vomit blood. Since many drugs are broken down in the liver, you can become extremely sensitive to your medications and extremely vulnerable to side effects. And if the toxins normally eliminated by the liver begin to accumulate in the brain, you can become forgetful, insensitive and indifferent to your personal appearance.

How is non-alcoholic cirrhosis diagnosed?

Your doctor can detect liver damage by measuring the levels of certain enzymes in your blood. If the enzymes are elevated, an ultrasound or CT scan can often identify the nature of the damage. If there are still questions, doctors may take a small sample of tissue (biopsy) using a needle to make a diagnosis and determine the extent of damage.

How is non-alcoholic cirrhosis treated?

In some cases, doctors can slow cirrhosis by targeting the source. For example, chronic hepatitis B and hepatitis C infections can be controlled with antiviral drugs, and autoimmune hepatitis often responds to drugs that suppress the immune system.

Whatever the cause of your cirrhosis, protecting your liver should be a top priority for you and your doctor. First of all, you need to avoid alcohol. You may also need to reduce the dose of your medications or stop taking them altogether. Make sure your doctor knows about all the medications you are taking, including over-the-counter medications and even natural remedies and supplements, as many herbs can damage the liver. You can give your liver an extra boost by eating a healthy, nutrient-dense diet.

With proper treatment, many people with cirrhosis can still lead active lives, especially if their condition is detected at an early stage. But not all patients can live with the damage. If serious complications arise or the liver shuts down completely, a liver transplant may be your best hope for survival. Once the new liver is in place, you have a good chance of recovery. The five-year survival rate for liver transplant patients is 75%. Unfortunately, livers are rare, waiting lists can be long, and not all patients are healthy enough to survive the operation.

Cleveland Clinic, Cirrhosis of the Liver: What It Is, Symptoms, Causes and Stages

The American Association of Gastroenterology. Liver cirrhosis.

National Digestive Diseases Clearinghouse. Liver cirrhosis.

American Liver Foundation. Cirrhosis.

American Liver Foundation. Liver transplant.