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Alcohol not only cause of cirrhosis

The Baltimore Sun

Nearly 17.6 million adults in the United States are alcoholics or have an alcohol problem, according to the National Institutes of Health. Between 10 percent and 20 percent of heavy drinkers develop cirrhosis of the liver, which is the 12th leading cause of death by disease. But alcoholism is not the only risk factor for this disease, says Dr. Paul Thuluvath, medical director of the Institute for Digestive Health & Liver Diseases and the director of the Center for Liver & Biliary Diseases at Mercy Medical Center.

What is cirrhosis?

The liver is the largest organ in the body. Whenever there is inflammation in the liver, the body tries to heal itself, and, in the process, forms scar tissue. As more scar tissue forms, the entire liver becomes shrunken and nodular. Most of the liver cells disappear, and the organ becomes mostly scar tissue with liver cells in between.

What are the risk factors for cirrhosis?

Cirrhosis can be due to many causes, but the most common is alcohol - if a man drinks more than three drinks a day or a woman drinks more than two drinks a day, that is considered excessive. Only a minority of people who drink like that will develop cirrhosis, but the numbers are high when you look at how many people drink in excess.

The second most common cause is hepatitis C. We have about 4 million people in the Unites States with hepatitis C, and 20 percent of those patients with hepatitis C will progress to cirrhosis. Hepatitis B (which affects about 1.25 million people) is a major cause of cirrhosis and liver cancer among immigrants from Asia and Africa.

Among the other causes also is what we call nonalcoholic fatty liver disease (NAFLD). This is mainly caused because the people in this country and elsewhere in the world are becoming more and more obese, and develop diabetes (insulin resistance), and high cholesterol and triglycerides. This is a disease potentially preventable by diet and exercise.

What are the symptoms of cirrhosis of the liver?

Most people in the early stages will experience no symptoms at all. The diagnosis frequently is missed for that reason. But early symptoms could include fatigue and minimal swelling in the legs. And in blood tests, doctors might find some elevation in the liver enzymes, and sometimes low albumin and low platelets.

As the disease progresses, the patient will develop swelling of the abdomen because of fluid accumulation and may experience sleep disturbances, confusion and memory loss. Bleeding from the stomach (vomiting blood or [having] black stools) is a serious, life-threatening complication. They also could develop liver cancer.

Is this a fast-progressing disease?

Most of the conditions that might cause it - such as hepatitis C and nonalcoholic fatty liver disease - progress fairly slowly over a period of 10 to 30 years.

But certain conditions, such as the disease when caused by drinking excessively or autoimmune hepatitis (in which the immune system attacks the liver cells), can progress more rapidly.

Is cirrhosis treatable?

Most of these conditions that predispose people to develop cirrhosis are treatable. Sixty percent of hepatitis C patients can be treated with medicine, and if treated early enough, they may not progress to cirrhosis. Even those in the early stages of cirrhosis can heal. Similarly, hepatitis B is treatable in most people these days. Many other conditions that cause liver disease, such as autoimmune hepatitis, hemochromatosis (too much iron in the liver) and Wilson's disease (too much copper), are potentially treatable if diagnosed early.

In cases involving alcohol, there is no medication. If the person stops drinking, however, the liver can regenerate, but the person has to stop drinking completely.

One area in which we still do not have good treatment is the nonalcoholic fatty liver disease (NAFLD). The only thing to do is to lose weight, which is sometimes very difficult to do.

What do patients with liver disease need to know?

Early detection is important. Early diagnosis can lead to better prognosis, as the liver can regenerate. Advanced cirrhosis can only be managed by liver transplantation.

All doctors (particularly family physicians, pediatricians and internists) need to recognize that even minimal changes in liver enzymes can mean significant disease. ... Many doctors will say, "Come back in six months or a year," and then it is too late.

People who are at high risk [for hepatitis] - because of IV drug use, transfusion, multiple sexual partners - should be screened for hepatitis B and C. And everyone, and especially those with liver disease, should get vaccination for hepatitis A and B.

Holly Selby is a former reporter for The Baltimore Sun.

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