There’s hope for patients living with cirrhosis

Hepatologists examine the state of the art for the diagnosis and management of the chronic liver disease

July 19, 2023 5:00 AM

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Cirrhosis affects over two million adults in the United States and can be quite debilitating. Individuals with the condition often experience things like confusion, falls, fluid buildup in the belly, muscle cramps, excessively itchy skin and disrupted sleep patterns.

“Many people simply don’t see a way out because cirrhosis severely impacts their daily quality of life,” said Elliot Tapper, M.D., a hepatologist at Michigan Medicine who regularly treats patients with severe liver disease.

In fact, many clinicians also feel similarly pessimistic. But Tapper adds that there is hope.

“When the word cirrhosis is mentioned, it can be very alarming. And sadly, the condition is becoming more and more prevalent among young people,” he said. “But now, more innovative tools exist than ever before, making the detection and treatment of cirrhosis much more effective.”

Tapper teamed up with fellow Michigan Medicine hepatologist, Neehar Parikh, M.D., M.S., to examine the state of the art in the diagnosis and management of cirrhosis. Their subsequent review was recently published in JAMA.

The team’s most prominent findings involved:

A three-year randomized trial of 201 patients with portal hypertension, a condition generally caused by cirrhosis of the liver: “We observed that non-selective beta blockers significantly reduced the risk of disease progression and death in these patients,” said Tapper.
A meta-analysis of randomized trials with 172 patients that involved lactulose, which is a laxative and ammonia reducer: “This drug showed great promise when it came to lowering mortality and hepatic encephalopathy rates in patients with severe liver disease,” said Tapper.
A clinical trial that showed improved rates of reversal for hepatorenal syndrome – one of the deadliest complications of cirrhosis – when patients were given the drug, Terlipressin.

Tapper adds that these findings offer “a lot of promise,” given that 40% of individuals with cirrhosis “are diagnosed with complications like hepatic encephalopathy or ascites and the survival rates are initially fairly low.”

When the word cirrhosis is mentioned, it can be very alarming. And sadly, the condition is becoming more and more prevalent among young people. But now, more innovative tools exist than ever before, making the detection and treatment of cirrhosis much more effective.”

– Elliot Tapper, M.D.

He also notes that there’s hope around improving the quality of life for the millions of people who suffer daily due to this condition.

“Remarkably, we also noticed significant improvements in cirrhotic symptoms upon our review of our cohort of studies,” said Tapper.

“We found that sleep dysfunction was commonly treated with hydroxyzine, which is an antihistamine, and a combination of pickle brine and taurine repeatedly improved muscle cramps, which can be extremely debilitating for patients dealing with this condition. We also found that tadalafil, a commonly used vasodilator, improved sexual dysfunction in men.”

Paper cited: “Diagnosis and management of Cirrhosis and its Complications: A Review,” JAMA. DOI: 10.1001/jama.2023.599

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