Cirrhosis

Cirrhosis

The liver is the largest organ in the body which performs fundamental functions such as blood protein production, sugar storage, removal of damaging substances and bile making. When this organ gets diseased for a long time, it proceeds to a final condition called cirrhosis. This condition is typified by liver scarring and poor organ performance. ^{[1] [2]}

Epidemiology

The condition is the 9^th cause of mortality in the United States. Patients who die are usually in the 5^th to 6^th decade of life. ^[3]

Causes

Majority of cases in the United States before are attributed to alcoholic liver disease. Hepatitis C has now emerged as the top cause. Other causes of cirrhosis include autoimmune hepatitis, bile duct diseases, Wilson disease, hemochromatosis, NonAlcoholic SteatoHepatitis (NASH), sarcoidosis, venous outflow obstruction, chronic right sided heart failure and certain drugs like methotrexate, amiodarone and alpha methyldopa. ^{[2] [3]}

Signs and Symptoms

In the early stages, the person often does not notice any symptom. As the liver becomes more damaged as time goes by, the symptoms that may manifest include fatigue, loss of appetite, easy bleeding, easy bruising, skin itching, vomiting, leg swelling, abdominal girth enlargement and yellowing of skin and sclera (whitish portion of the eyes). Some may also have redness on the palms, clay colored stools and spider-like blood vessels on the skin surface. Male patients may have impotence and breast swelling. When the condition gets more severe, the brain may be affected and the individual can have personality changes, confusion and coma. ^{[2] [4]}

Diagnosis

After the medical history and physical examination, the patient is often requested to undergo a series of laboratory tests including complete blood count, liver function tests and tests that check prothrombin time and blood albumin level. Imaging tests are frequently necessary such as abdominal ultrasound. Liver biopsy is a confirmatory test. ^[2]

Treatment

Liver scarring is not reversible. The objective of treatment is to slow down the process or thwart further injury. Depending on the underlying disease, drugs may be prescribed like azathioprine for autoimmune hepatitis and antiviral agents for hepatitis. When there is infection, antibiotics are given. Lifestyle changes are extremely important like alcohol and diet control. Endoscopic treatment may be needed for enlarged blood vessels in the throat. Patients in end stages may need liver transplant. ^{[2] [3]}

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Megavitamin Therapy (Multivitamin, Vitamin Supplements) [5, 6, 7, 8, 9, 10, 11]:

Please Note that while supplements are effective in correcting deficiencies in the body, their long-term usage is not helpful in preventing diseases like cancer and heart disease. To prevent these illnesses one should eat the natural foods which these vitamins and minerals come from. Replacing natural sources with artificial supplements actually increases the risk of heart disease, cancer, and other diseases. Supplements should be taken only as a balanced multivitamin supplement that contains no more than 100% of the recommended daily allowance. It would be most helpful in people with restricted food intakes, pregnant women and women of childbearing age.

Recommendation: Weakly against. (There is no evidence that Megavitamin therapy can prevent or treat coronary heart disease. In fact, long term therapy can lead to increased risk)

Grade of Evidence: moderate quality of evidence

Milk Thistle:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. 

Recommendation: Weakly in favor (Early reports support claims that Milk Thistle helps treat cirrhosis. However, more research is needed, as current studies have yielded mixed results)

Grade of Evidence: Low quality of evidence

Germanium (Germanium Sesquioxide, Vitamin O):

WARNING: Germanium may cause permanent Kidney failure. Even organic supplements, though less toxic than inorganic supplements, have caused kidney and liver damage. NOT TO BE USED.

Recommendation: Strongly against (Evidence shows that Germanium is not effective in treating cirrhosis in any way, and is also toxic, causing severe kidney and liver damage.)

Grade of Evidence: Moderate quality of evidence

Chlorella (Green Algae, Chlorella Pyrenoidosa):

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Chlorella helps to treat cirrhosis in any way)

Grade of Evidence: very low quality of evidence

Hyperbaric Oxygen Therapy (HBOT):

NOT RECOMENDED

Recommendation: strongly against (available evidence shows that HBOT is in no way useful in treating cirrhosis, and can have harmful effects. NOT RECOMENDED)

Grade of Evidence: Moderate quality of evidence

* www.gradeworkinggroup.org

Summary References

1. http://www.webmd.com/digestive-disorders/cirrhosis-liver

2. http://www.nlm.nih.gov/medlineplus/ency/article/000255.htm

3. http://emedicine.medscape.com/article/185856-overview#aw2aab6b4

4. http://www.patient.co.uk/health/cirrhosis

Treatment References

5. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

6. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/orthomolecular-medicine

7. http://archpedi.ama-assn.org/cgi/reprint/163/2/192.pdf

8. http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html

9. http://pediatrics.aappublications.org/cgi/content/abstract/72/5/707

10. http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml

11. http://www.ncbi.nlm.nih.gov/pubmed/17327526

 

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