Cirrhosis: the most effective dietary supplements

Cirrhosis is a chronic and irreversible liver disease characterized by a progressive transformation of normal hepatic tissue into fibrous tissue. This diffuse fibrosis is accompanied by the formation of regenerative nodules, resulting in a severe disruption of the liver’s structure and function. As cirrhosis advances, the liver becomes progressively less able to perform its essential functions, such as detoxifying the blood, synthesizing proteins, and producing bile, leading to serious complications.

Pathophysiology

Cirrhosis is primarily caused by chronic injury to the liver, which can result from viral infections (hepatitis B, C), alcohol abuse, or metabolic disorders. This injury leads to continuous activation of hepatic stellate cells, which play a central role in the fibrosis process. Normally responsible for storing vitamin A, these cells transform into collagen-producing cells during liver injury. Collagen accumulates and alters the normal architecture of the hepatic sinusoids, disrupting exchanges between the blood and hepatocytes. Excessive accumulation of extracellular matrix (ECM) in the liver reduces the exchange of oxygen and nutrients, which worsens fibrosis. Additionally, this situation causes anoxia (lack of oxygen) at the level of hepatic cells, promoting the production of free radicals. These free radicals, in turn, stimulate the formation of fibrous tissue, making the process self-perpetuating and aggravating the disease.

Symptoms

Cirrhosis can present insidiously, with nonspecific symptoms in the early stages. Patients may experience general weakness, weight loss, decreased appetite, and abdominal pain. In more advanced stages, more specific signs appear, including: • Jaundice (yellowing of the skin and eyes) due to the accumulation of bilirubin. • Pruritus (itching), related to increased bile salts in the blood. • Ascites, accumulation of fluid in the abdomen due to portal hypertension. • Edema, often localized to the ankles, due to fluid retention. • Gastrointestinal bleeding related to the rupture of esophageal varices, a complication of portal hypertension. • Hepatic encephalopathy, which manifests as neurological disturbances, from confusion to coma, due to the accumulation of toxins in the blood that the damaged liver can no longer eliminate properly.

Etiologies

Several causes can lead to cirrhosis, including: • Chronic infections: Viral hepatitis B and C are major causes of cirrhosis worldwide. • Alcoholism: Chronic alcohol consumption is a common cause in Western countries. • Nonalcoholic fatty liver disease: Linked to obesity and metabolic syndrome, this condition can progress to cirrhosis in some patients. • Metabolic diseases: Certain disorders, such as hemochromatosis (iron overload) or Wilson disease (copper accumulation), can cause severe liver damage. • Chronic cholestasis: Diseases of the bile ducts, such as primary biliary cholangitis or primary sclerosing cholangitis, impair bile elimination and progressively damage the liver. • Autoimmune causes: Autoimmune hepatitis can cause chronic liver inflammation that progresses to cirrhosis.

Complications

Cirrhosis is a progressive disease that leads to serious complications: Portal hypertension: Fibrosis of the liver disrupts normal blood flow, causing increased pressure in the portal vein, which can lead to esophageal varices and bleeding. Ascites: The accumulation of fluid in the abdominal cavity is a common complication due to portal hypertension and hypoalbuminemia (a decrease in blood proteins). Hepatic encephalopathy: Patients may develop severe neurological symptoms caused by the accumulation of toxins that the liver can no longer eliminate. Hepatocellular carcinoma: Liver cancer is a frequent complication in patients with advanced cirrhosis.

Diagnosis

The diagnosis of cirrhosis is based on a thorough clinical examination and a series of paraclinical tests. Patients presenting signs such as jaundice, ascites, or abnormal liver enzymes (such as elevated transaminases) should be evaluated with blood tests, ultrasound examinations, and, in some cases, liver biopsies to confirm the presence of fibrosis and regenerative nodules. Hepatic elastography, a noninvasive technique, can also measure liver stiffness and assess the degree of fibrosis.

Treatment

Management of cirrhosis includes: • Removal of the causal agent: for example, stopping alcohol consumption. • Treatment of the underlying cause: antivirals for viral hepatitis, immunosuppressants for autoimmune hepatitis. • Treatment of complications: diuretics for ascites, antibiotics for infections, lactulose for encephalopathy. • Liver transplantation: an option for patients with decompensated cirrhosis​​. The management of cirrhosis requires a multidisciplinary approach and continuous monitoring to prevent and treat the serious complications associated with this chronic disease.