Early Cirrhosis: Autoimmune Liver Disease Insights and Management

Liver issues - Cirrhosis

Hello Doctor, two years ago during a health check-up, fetal alpha-fetoprotein was found to be 13.8, and both GOT and GPT levels were elevated.
An ultrasound indicated that the liver appeared enlarged, suggesting liver fibrosis.
Blood tests ruled out hepatitis B and alcohol consumption, leading to a diagnosis of autoimmune-related liver fibrosis (though the degree of fibrosis was unknown).
After taking medication for a while, liver enzyme levels returned to normal.
Recently, I underwent blood tests and a liver fibrosis assessment, which indicated a score of 12, suggesting early-stage cirrhosis, but liver enzyme levels are normal.
Previously, my platelet count was as low as 60,000, and I have been taking steroids (Lerazone), which increased my platelet count to 110,000.
The doctor mentioned that since I am on steroids, there is no need for additional medication, and I should have check-ups every six months.

My question is, Doctor Chen, is it possible to progress from fibrosis to cirrhosis in just two years? Is it true that early-stage cirrhosis does not require further medication? What can I do to prevent deterioration? Is there a way to restore liver function in cases of autoimmune-related cirrhosis? Thank you, Doctor Chen, for your patience in reading this.

Niming, 40~49 year old female. Ask Date: 2020/06/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

Your situation is quite unique; there is significant individual variation in autoimmune hepatitis, and medication regimens can differ accordingly.
Therefore, it is essential to tailor the treatment to your specific condition.
Please discuss this further with your attending physician.

Reply Date: 2020/06/26

More Info

Understanding early cirrhosis, especially in the context of autoimmune liver disease, requires a nuanced approach. Autoimmune liver diseases, such as autoimmune hepatitis, can lead to liver fibrosis and, eventually, cirrhosis if not managed appropriately. Your situation, where you transitioned from liver fibrosis to early cirrhosis within a relatively short period, is indeed concerning but not uncommon in autoimmune conditions.

Firstly, it’s important to clarify that liver fibrosis and cirrhosis are part of a continuum of liver disease. Fibrosis refers to the accumulation of scar tissue in the liver, while cirrhosis indicates more advanced scarring that can lead to liver dysfunction. The progression from fibrosis to cirrhosis can vary significantly among individuals, influenced by factors such as the underlying cause, the presence of inflammation, and the effectiveness of treatment. In autoimmune liver diseases, the inflammatory process can be aggressive, leading to rapid progression in some cases.

In your case, the fact that your liver enzymes (GOT and GPT) returned to normal after treatment is a positive sign. It suggests that the inflammation may have been controlled, which is crucial in preventing further damage. However, the diagnosis of early cirrhosis indicates that some degree of irreversible damage has occurred. The liver's ability to regenerate is remarkable, but it has its limits, especially once cirrhosis has developed.

Regarding your question about whether you need to continue medication, it’s essential to follow your doctor’s advice closely. Corticosteroids, like the one you mentioned (樂而爽), are commonly used to manage autoimmune hepatitis and can help reduce inflammation and prevent further liver damage. If your doctor has advised that you do not need additional medications at this time, it may be because your liver function tests are stable, and your platelet count has improved. However, regular monitoring is crucial, as autoimmune conditions can fluctuate.

To maintain your liver health and prevent further deterioration, consider the following strategies:
1. Regular Monitoring: Continue with regular follow-ups and blood tests as recommended by your healthcare provider. This will help catch any changes early.

2. Healthy Lifestyle: Adopt a liver-friendly lifestyle. This includes a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Avoid high-fat, high-sugar foods, and limit salt intake to manage any fluid retention.

3. Avoid Alcohol: Since alcohol can exacerbate liver damage, it’s crucial to abstain completely.

4. Manage Other Health Conditions: Conditions like diabetes, hypertension, and high cholesterol can complicate liver disease. Managing these effectively can help protect your liver.

5. Stay Hydrated: Adequate hydration is essential for overall health and can help your liver function optimally.

6. Exercise Regularly: Engaging in regular physical activity can help maintain a healthy weight and improve overall liver health.

7. Avoid Certain Medications: Be cautious with over-the-counter medications and supplements, as some can be harmful to the liver. Always consult your doctor before starting any new medication.

8. Educate Yourself: Understanding your condition can empower you to make informed decisions about your health. Stay informed about autoimmune liver diseases and their management.

As for the possibility of reversing cirrhosis, while early-stage cirrhosis may allow for some recovery of liver function, it is generally not reversible. However, with appropriate management and lifestyle changes, it is possible to halt or slow the progression of liver disease and maintain a good quality of life.

In conclusion, while the transition from fibrosis to early cirrhosis in two years is concerning, it is not entirely unusual in autoimmune liver disease. Close monitoring, adherence to treatment, and lifestyle modifications are key to managing your condition effectively. Always maintain open communication with your healthcare provider to ensure the best possible outcomes for your liver health.

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