Liver disease represents a significant global health challenge, affecting millions worldwide. It is responsible for approximately two million deaths annually, accounting for about 4% of all deaths globally. The liver performs numerous functions, including detoxification, nutrient processing, and energy storage, making its health crucial for overall well-being. Liver conditions often advance silently, with many experiencing no noticeable symptoms until a more advanced stage.
This silent progression underscores the importance of early diagnosis and timely intervention. Identifying liver problems early allows for effective treatment strategies and lifestyle adjustments. Such action can prevent further damage, slow disease progression, and in some cases, even reverse liver damage. Without appropriate management, liver disease can lead to severe complications, including irreversible scarring (cirrhosis), liver failure, or liver cancer. Addressing liver disease promptly is fundamental to preserving liver function and improving long-term health outcomes.
Lifestyle and Dietary Management
Managing liver disease often begins with lifestyle and dietary adjustments. For alcohol-related liver disease, complete abstinence from alcohol is a primary recommendation, as continued consumption can lead to cirrhosis. Even in other forms of liver disease, minimizing or avoiding alcohol reduces strain on the liver.
Achieving and maintaining a healthy body weight is particularly impactful, especially for metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease. Losing even 3-5% of body weight can improve liver health, while a 10% reduction may help reverse liver scarring. Gradual weight loss, typically 0.5 to 2 pounds per week, through a combination of reduced calorie intake and increased physical activity, is generally advised.
A balanced diet supports liver health, emphasizing fruits, vegetables, whole grains, lean proteins, and healthy fats (e.g., olive oil, nuts, fatty fish). Limiting processed foods, sugary beverages, refined carbohydrates, and saturated or trans fats is also important to reduce fat accumulation and inflammation in the liver. The Mediterranean diet, with its focus on whole, unprocessed foods, aligns well with these recommendations.
Regular physical activity (at least 150 minutes of moderate-intensity exercise weekly) aids weight management, improves insulin sensitivity, and reduces liver fat. Managing co-existing conditions like diabetes and high cholesterol through lifestyle interventions further protects the liver. This includes controlling blood sugar through dietary choices and regular exercise, and lowering cholesterol by increasing fiber and reducing unhealthy fats in the diet.
Medical Therapies
Medical therapies target specific causes of liver disease. For chronic viral hepatitis B, antiviral drugs (e.g., entecavir, tenofovir) are administered long-term to suppress viral replication. Immune modulators, like interferons, are also available, though they have more significant side effects and are used for shorter durations.
Hepatitis C treatment has been revolutionized by direct-acting antiviral (DAA) tablets. These highly effective medications typically clear the virus in over 90% of individuals, often within 8 to 12 weeks, with minimal side effects, by directly inhibiting viral replication.
Autoimmune hepatitis is managed with immunosuppressive medications. Corticosteroids (e.g., prednisone) are often used initially to control inflammation, frequently combined with other immunosuppressants like azathioprine for sustained remission. Mycophenolate mofetil or tacrolimus may be used as alternatives if initial treatments are ineffective or poorly tolerated.
For metabolic dysfunction-associated steatohepatitis (MASH), resmetirom (Rezdiffra) represents the first FDA-approved medication. This oral drug is used with diet and exercise for patients with moderate to advanced liver scarring without cirrhosis, by targeting lipid metabolism. Other emerging therapies, including peroxisome proliferator-activated receptor agonists and glucagon-like peptide-1 analogs, are currently under investigation.
Genetic liver conditions also have specific drug treatments. Wilson’s disease, characterized by excessive copper accumulation, is treated with chelating agents (e.g., D-penicillamine or trientine) that facilitate copper excretion. Zinc salts are also used for maintenance by inhibiting copper absorption. In hemochromatosis, an iron overload disorder, iron chelating agents (e.g., deferoxamine) are used when phlebotomy is not feasible to remove excess iron.
Cholestatic liver diseases, where bile flow is impaired, also benefit from medication. Primary biliary cholangitis (PBC) is treated with ursodeoxycholic acid (UDCA), which improves bile flow and protects liver cells. Obeticholic acid is an additional option for those with an inadequate response to UDCA. For primary sclerosing cholangitis (PSC), there is currently no proven pharmacological therapy that alters disease progression; treatments focus on symptom management.
Drug-induced liver injury (DILI) primarily requires discontinuing the offending medication. Most cases resolve spontaneously. For certain toxicities, such as acetaminophen overdose, specific antidotes like N-acetylcysteine mitigate liver damage.
Advanced Interventions
When liver disease progresses despite other therapies, more invasive interventions may be necessary. Paracentesis is a procedure to drain fluid from the abdominal cavity (ascites) using a needle or catheter. It relieves symptoms like abdominal distension and breathing difficulties when diuretics and sodium restriction are insufficient. It can also be diagnostic.
Endoscopic variceal ligation (EVL) uses an endoscope to place small rubber bands around varices, cutting off blood supply to prevent or stop bleeding. The Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive radiological procedure. It creates a bypass within the liver using a stent, connecting the portal vein to a hepatic vein to reduce high pressure in the portal system. TIPS is considered when variceal bleeding or ascites are refractory to other treatments.
For end-stage liver disease, acute liver failure, or certain liver cancers, liver transplantation offers a definitive solution. This major surgical procedure replaces the diseased liver with a healthy one from a deceased or living donor. Transplantation aims to restore normal liver function, alleviate complications, and improve long-term survival and quality of life. It is reserved for carefully selected candidates.
Managing Complications
As liver disease progresses, various complications can arise, requiring specific management. Hepatic encephalopathy, a brain dysfunction from toxin accumulation (e.g., ammonia), is managed by addressing precipitating factors like infections. Lactulose reduces ammonia by promoting bowel movements, while antibiotics like rifaximin decrease ammonia-producing gut bacteria.
Ascites, fluid buildup in the abdomen, is managed through dietary sodium restriction and diuretics (e.g., spironolactone, furosemide). For large or persistent accumulation, therapeutic paracentesis provides immediate relief.
Variceal bleeding, a life-threatening complication of portal hypertension, is prevented with non-selective beta-blockers to reduce portal vein pressure. Endoscopic band ligation also places rubber bands around enlarged veins to prevent rupture.
Kidney dysfunction, known as hepatorenal syndrome, can occur in advanced liver disease. Management involves vasoconstrictors (e.g., terlipressin) and albumin to improve kidney blood flow. While these therapies stabilize kidney function, liver transplantation remains the definitive treatment. Supportive and palliative care focuses on symptom management and enhancing quality of life.