Cirrhosis - Treatment

It has no effect on symptoms, including itching and fatigue. Some drugs, such as colchicine, corticosteroids, or immunosuppressants, are being investigated for use in combination with UDCA. Long-term controlled trials are needed to determine the value of UDCA alone or with other agents.

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Agents for Itching. Itching is a major problem with this disease. Cholestyramine, taken with meals, is the first choice for relieving itching. and a number of agents have been used or investigated, including low doses of the drug naltrexone and phototherapy.

Agents for Impaired Fat Absorption. Because primary biliary cirrhosis affects fat absorption, patients may need high doses or injections of important fat-soluble vitamins, including K, D, A, and E. Agents called medium-chain triglycerides may be helpful for steatorrhea (in which the feces contain excessive fat).

Treatments for Other Causes of Cirrhosis

Treatment of Nonalcoholic Fatty Liver Disease (NASH). Weight loss is the most important component for managing NASH and preventing progression to liver disease. Investigators are studying various drugs, insulin-sensitizing drugs metformin, rosiglitazone, and pioglitazone, as well as the antioxidant vitamin E.

Secondary Biliary Cirrhosis. Secondary biliary cirrhosis caused by blockage in the bile ducts can be relieved by surgery.

Autoimmune Hepatitis. Autoimmune hepatitis is treated with corticosteroids as standard agents and also possibly immunosuppressants, such as azathioprine and cyclosporine A.

Hemochromatosis. For hemochromatosis, weekly bleedings (phlebotomies) may be performed until iron levels are normal, then repeated as needed. If treatment is given before cirrhosis develops, life expectancy may be normal.

Wilson's Disease. D-penicillamine is the drug most used for Wilson's disease.

Treatments for Liver Scarring

Presently, there are no safe and effective therapies for liver scarring (fibrosis). However, recent insights into the cellular and molecular mechanisms responsible for scarring have led to the development of specific, antifibrotic agents that target the primary injury and/or inhibit abnormal cell mechanisms. Such agents, now in very early testing, could one day help prevent or reduce the progression of liver scarring or the progression to liver cancer.