Liver cirrhosis occurs when chronic injury causes healthy hepatic tissue to be replaced by scar tissue, reducing the liver’s ability to work normally. While heavy alcohol use is a well-known cause, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), autoimmune and genetic disorders can also lead to cirrhosis. Treatment aims to slow damage, control symptoms, prevent complications, and preserve quality of life.

Core treatment approaches

Treatment is individualized based on the underlying cause, degree of liver damage, and the presence of complications. Major strategies include:

• Addressing the root cause: Stopping alcohol intake is essential when alcohol is the culprit. For viral hepatitis, antiviral therapies can suppress or eliminate the virus and reduce ongoing injury. Metabolic risk factors such as obesity, insulin resistance, and dyslipidemia should be treated in cases of NAFLD. Autoimmune or cholestatic liver diseases may require immunosuppression or disease-specific therapies.

• Lifestyle and supportive measures: Nutritional optimization, weight management, and regular, appropriate physical activity help slow progression and improve overall health. For many patients, a low-sodium diet reduces fluid retention. Avoiding hepatotoxic drugs and illicit substances is critical.

• Medications: Drugs do not reverse cirrhosis but can treat complications and limit harm. Diuretics manage ascites, lactulose and rifaximin treat hepatic encephalopathy, nonselective beta-blockers reduce the risk of variceal bleeding, and antibiotics may prevent or treat infections associated with cirrhosis.

• Procedures and interventions: Paracentesis removes large-volume ascites. Endoscopic banding or sclerotherapy treats bleeding esophageal varices. Transjugular intrahepatic portosystemic shunt (TIPS) can reduce portal hypertension in selected patients.

• Liver transplantation: For advanced, decompensated cirrhosis or when complications cannot be controlled, transplantation replaces the diseased liver. It is a complex option requiring careful evaluation and lifelong follow-up.

How cirrhosis is diagnosed and monitored

A combination of clinical assessment, laboratory testing, and imaging is used to confirm cirrhosis and follow its course:

• Blood tests: Liver enzymes, bilirubin, albumin, INR, platelet count, and specific viral serologies and autoimmune markers help evaluate function and identify causes. Scores such as MELD (Model for End-Stage Liver Disease) estimate severity.

• Imaging: Ultrasound, CT, or MRI can show a shrunken, nodular liver, signs of portal hypertension, and focal lesions. Ultrasound is often the first-line imaging tool.

• Noninvasive fibrosis assessment: Transient elastography (FibroScan) measures liver stiffness and helps stage fibrosis without a biopsy.

• Liver biopsy: When diagnosis is unclear or when precise staging will change management, a biopsy provides microscopic detail.

• Ongoing surveillance: Patients with cirrhosis need regular follow-up for liver cancer surveillance (typically ultrasound +/- AFP every 6 months), endoscopic screening for varices, and routine labs to detect worsening function.

Key lifestyle changes that help

Daily habits have a major impact on outcomes:

• Complete abstinence from alcohol for alcohol-related disease.
• Low-sodium diet to reduce ascites and edema; individualized calorie and protein recommendations to prevent malnutrition.
• Avoid raw or undercooked shellfish to lower the risk of Vibrio and other infections.
• Update vaccinations for hepatitis A and B (if not immune), influenza, and pneumococcus.
• Review all medications and supplements with a clinician; many over-the-counter drugs (including excessive acetaminophen) can be harmful.
• Achieve and maintain a healthy weight and control diabetes, hypertension, and cholesterol when present.

Common and serious complications

Cirrhosis can produce life-threatening problems that require prompt treatment:

• Portal hypertension: Elevated pressure in the portal venous system causing collateral vessels and varices.
• Ascites: Fluid accumulation in the abdomen that can impair breathing and mobility.
• Hepatic encephalopathy: Cognitive changes from toxin buildup that ranges from mild confusion to coma.
• Esophageal and gastric variceal bleeding: Potentially massive hemorrhage requiring urgent care.
• Hepatocellular carcinoma (HCC): Cirrhosis increases the risk of primary liver cancer; surveillance is important.
• Renal dysfunction, including hepatorenal syndrome, and increased susceptibility to infections.

When transplant is considered

Transplant evaluation is recommended for patients with decompensated cirrhosis or complications that are refractory to standard treatment. Indications may include recurrent encephalopathy, refractory ascites, uncontrolled variceal bleeding, or liver cancer that meets transplant criteria. Candidates undergo a multidisciplinary assessment covering medical fitness, psychosocial factors, and contraindications such as active substance use. Priority for deceased-donor organs is often guided by MELD scores, while living-donor transplant is an alternative in some centers.

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Treatment option	What it addresses	Notes
Cause-specific therapy	Stops or slows ongoing liver injury	Examples: antivirals for hepatitis, alcohol cessation, weight loss for NAFLD
Lifestyle adjustments	Reduce progression and complications	Diet, vaccinations, medication review
Medications	Symptom and complication control	Diuretics, lactulose, beta-blockers, antibiotics
Procedures (paracentesis, banding, TIPS)	Manage fluid, bleed, portal hypertension	Often used when medical therapy is insufficient
Liver transplant	Replace failed liver	For selected patients with end-stage disease

Cost disclaimer: Treatment costs vary widely by region, provider, and insurance; this table does not provide price estimates and is for informational purposes only.

Final considerations

Cirrhosis is a chronic, potentially progressive disease, but many people can live well for years with appropriate care. Early diagnosis, targeted therapy for the cause, routine monitoring for complications, and a team approach involving hepatologists, dietitians, and transplant specialists provide the best chance to slow progression and maintain quality of life. Discuss any treatment decisions and prognostic questions with your healthcare provider to create an individualized plan.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.