Transplant hepatologist Sumera Ilyas, M.B.B.S. answers the most frequently asked questions about cirrhosis.

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Ask Mayo Clinic: Cirrhosis

Sumera I. Ilyas, M.B.B.S., Transplant Hepatologist, Mayo Clinic Hi, I'm Dr. Sumera Ilyas, a transplant hepatologist at Mayo Clinic, and I'm here to answer some of the important questions you may have about cirrhosis.

Can I still drink alcohol with liver disease?

No amount of alcohol is considered safe in patients with cirrhosis. They should avoid all alcohol use.

Are pain medications safe to take with liver disease?

Well, some pain medications are safe to take in certain doses, and some are not. For instance, nonsteroidal, anti-inflammatory drugs such as ibuprofen and naproxen, they should be avoided in patients with cirrhosis, because when the liver is scarred, there's a greater chance of hurting the kidneys with these types of medications. Narcotics such as oxycodone are not a good idea either as they can be quite problematic with certain complications of cirrhosis. Acetaminophen, on the other hand, is safe to take, but at smaller doses. For pain relief in cirrhosis, we recommend taking acetaminophen up to two grams a day. So that's four extra strength tablets within a 24-hour period.

How can diet help manage my cirrhosis?

So it's important to eat an overall healthy diet that is balanced and full of fruits and vegetables. It's important to have protein intake, and that can be from lean sources of protein such as beans or lentils, and salt restriction is also very important. Limit the amount of salt in your diet to less than two grams of total intake a day.

Will taking supplements help my cirrhosis?

Although certain herbal supplements such as milk thistle have been tried in liver disease, there's no evidence to suggest that herbal supplements or any other alternative therapies can effectively treat cirrhosis. However, there is a chance of herbal supplements causing harm to the liver, sometimes to the point of liver failure requiring a liver transplant. So we recommend avoiding any and all herbal supplements.

Why are vaccines important with cirrhosis?

Well, vaccinations are an important preventive measure in patients with cirrhosis because when the liver is scarred, patients are at higher risk of complications from certain infections. For patients with cirrhosis, we recommend vaccination against hepatitis A and B. We also recommend the pneumococcal vaccine, which is commonly referred to as the pneumonia vaccine, for all adult patients with cirrhosis. And patients with cirrhosis should also get the annual flu shot.

How can I slow or reverse cirrhosis?

There are instances when damage to the liver can be slowed although complete reversal generally does not happen. For example, if a patient has cirrhosis due to alcohol use, we know that completely abstaining from alcohol can improve the function of the liver. Similarly, weight loss can help improve fatty liver disease. And cirrhosis from hepatitis C was a major reason patients required liver transplants, but we now have medications, antiviral drugs, that are very effective at curing it. There's evidence to suggest that getting rid of the hepatitis C can slow or maybe even help reverse some of the damage done. But there are instances when the liver disease is too advanced and medical interventions cannot reverse the process and that's when we consider liver transplantation.

How can I be the best partner to my medical team?

We know that this is tough for our patients and their loved ones and we want to do everything we can to make the process seamless for our patients. It's helpful for us if we have as much information about your condition as possible--any prior medical therapies, any new symptoms or signs, any medications, herbal supplements or any other medical conditions that you may have. Collect all of this information and share it with your liver team. Be open and transparent with your team. Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time, and we wish you well.

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Feb. 11, 2023