Is cirrhosis of the liver reversible? Indian journal of pediatrics Extensive and persistent hepatic fibrosis has for a long time been considered irreversible. Accumulating evidence suggests that liver fibrosis is reversible and that recovery from cirrhosis may be possible. The application of molecular techniques to models of reversible fibrosis are helping to establish the events and processes that are critical to recovery. The problem consists in identifying and eliminating its cause. Although fibrosis in the liver has little functional significance by itself, its severity derives from associated vascular changes. Disappearance of fibrosis can be accompanied by remodeling of vascular changes. However, depending on its duration, the fibrosis may be irreversible. 10.1007/s12098-007-0067-1

Understanding the Complexities of Cirrhosis. Muir Andrew J Clinical therapeutics PURPOSE:Cirrhosis and its related complications remain a prominent global health concern despite advances in understanding and treating the disorder. Early diagnosis and intervention strategies may reduce the impact of cirrhosis; however, it can be difficult for initial point-of-care health care providers to identify and refer patients with cirrhosis due to lack of knowledge and resources. This review examines current diagnostic strategies for cirrhosis and cirrhosis-related complications and the potential benefits of multidisciplinary care for patients with the disorder. METHODS:A PubMed search of the medical literature was conducted to identify current diagnostic methods and standards and ascertain the impact of multidisciplinary care on patients with cirrhosis. FINDINGS:Screening of patients at risk for cirrhosis has been recommended by several professional and governmental organizations. Unfortunately, identification of early-stage cirrhosis remains challenging despite development of novel calculations for risk (eg, aspartate transaminase-to-platelet count ratio) that use values from common, noninvasive laboratory tests to determine the extent of liver disease. Abnormal liver function test results and alterations in serum liver enzyme markers (eg, alanine and aspartate transaminases) may suggest cirrhosis in patients with chronic liver disease; however, they are not definitive. Liver biopsy is the gold standard for diagnosis and staging of cirrhosis, but its cost, invasiveness, and risk of complications have prompted the development of noninvasive tests (eg, elastography). Primary care physicians should be aware of the signs and symptoms of cirrhosis-related complications, particularly portal hypertension, and refer patients to specialists for further evaluation when warranted. IMPLICATIONS:Patients at risk for cirrhosis should be screened and the underlying etiologic factor(s) of the liver disease treated or appropriately managed when possible. Primary care physicians should be aware of the signs and symptoms of cirrhosis and its related complications and adopt a low threshold for referral to a specialist when the condition is suspected. An integrated, multidisciplinary approach to care between specialists and primary care physicians may improve early detection of cirrhosis and its related complications and strengthen management strategies. 10.1016/j.clinthera.2015.05.507

Emerging synthetic drugs for the treatment of liver cirrhosis. Fallowfield Jonathan Andrew,Jimenez-Ramos Maria,Robertson Andrew Expert opinion on emerging drugs : The number of deaths and prevalent cases of cirrhosis are increasing worldwide, but there are no licensed antifibrotic or pro-regenerative medicines and liver transplantation is a limited resource. Cirrhosis is characterized by extreme liver fibrosis, organ dysfunction, and complications related to portal hypertension. Advances in our understanding of liver fibrosis progression and regression following successful etiological therapy betray vulnerabilities in common and disease-specific mechanisms that could be targeted pharmacologically.: This review summarizes the cellular and molecular pathogenesis of cirrhosis as a preface to discussion of the current drug development landscape. The dominant indication for global pharma R&D pipelines is cirrhosis related to nonalcoholic steatohepatitis (NASH). We searched Clinicaltrials.gov, GlobalData, Pharmaprojects and PubMed for pertinent information on emerging synthetic drugs for cirrhosis, with a focus on compounds listed in phase 2 and phase 3 trials.: Although cirrhosis can regress following successful etiological treatment, there are no specific antifibrotic or pro-regenerative drugs approved for this condition. Obstacles to drug development in cirrhosis include intrinsic biological factors, a heterogeneous patient population, and lack of acceptable surrogate endpoints. Nevertheless, several synthetic drugs are being evaluated in clinical trials and the NASH field is rapidly embracing a drug combination approach. 10.1080/14728214.2021.1918099

Liver cirrhosis. Williams E J,Iredale J P Postgraduate medical journal Liver fibrosis and its related complications continue to represent a significant worldwide healthcare burden. Over the past decade there has been considerable improvement in our understanding of the cellular mechanisms and pathophysiology underlying hepatic fibrosis. This greater insight into the relevant basic sciences may lead to the development of novel treatment strategies designed to block the fibrogenic cascade or even enhance matrix degradation. In addition, there have been significant advances in the management of the complications of cirrhosis, with specific treatments now available for some conditions. Perhaps most notably, liver transplantation is now a highly successful treatment for end-stage liver disease and should be considered in all patients with chronic liver disease. 10.1136/pgmj.74.870.193

Cirrhosis: Diagnosis and Management. Smith Andrew,Baumgartner Katrina,Bositis Christopher American family physician Cirrhosis is the 12th leading cause of death in the United States. Newer research has established that liver fibrosis is a dynamic process and that early cirrhosis may be reversible. Only one in three people with cirrhosis knows they have it. Most patients with cirrhosis remain asymptomatic until the onset of decompensation. When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. The most common causes of cirrhosis are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. Additional testing is based on demographics and risk factors. Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis. Chronic liver disease management includes directed counseling, laboratory testing, and ultrasound monitoring. Treatment goals are preventing cirrhosis, decompensation, and death. Varices are monitored with endoscopy and often require prophylaxis with nonselective beta blockers. Ascites treatment includes diuresis, salt restriction, and antibiotic prophylaxis for spontaneous bacterial peritonitis, when indicated. Hepatic encephalopathy is managed with lifestyle and nutritional modifications and, as needed, with lactulose and rifaximin. Hepatocellular carcinoma screening includes ultrasound screening every six months for patients with cirrhosis.