Definition
Liver cirrhosis is a chronic, progressive liver disease characterized by extensive fibrosis and restructuring of the organ’s normal architecture. It leads to loss of liver function and can cause severe complications.

Pathogenesis
Cirrhosis is the end stage of chronic liver diseases such as alcoholic liver disease, chronic hepatitis B and C, non-alcoholic steatohepatitis, and autoimmune or metabolic disorders. Chronic inflammation and destruction of liver cells result in their replacement with fibrotic tissue.

Diagnosis
Diagnosis is based on the patient’s history, clinical symptoms (such as fatigue, jaundice, abdominal swelling), and laboratory tests (elevated liver enzymes, reduced albumin). Imaging (ultrasound, CT, MRI, elastography) and liver biopsy confirm the diagnosis and assess fibrosis stage.

Treatment
Treatment focuses on managing the underlying cause and preventing complications:

  • Causal treatment: Abstinence from alcohol, treatment for hepatitis B or C, or control of metabolic factors.
  • Managing complications: Medications for ascites, preventing variceal bleeding, and controlling hepatic encephalopathy.
  • Liver transplantation: The only definitive treatment for advanced cirrhosis with liver function decompensation.

Early diagnosis and close monitoring by a hepatologist are essential for maintaining quality of life and preventing complications such as hepatocellular carcinoma.

Key figures: Under Baveno VII, screening endoscopy can be avoided when liver stiffness is below 20 kPa and platelets exceed 150,000. A value below 10 kPa makes advanced chronic liver disease unlikely, while above 15 kPa it is considered likely.

Common causes include metabolic fatty liver disease, chronic viral hepatitis and alcohol. Complications include oesophageal and gastric varices and hepatocellular carcinoma.

Frequently asked questions

Is cirrhosis reversible?

Fibrosis before cirrhosis is reversible when the cause is removed, for example after curing hepatitis C, stopping alcohol or achieving sustained weight loss in metabolic liver disease. Established cirrhosis generally does not fully reverse, but it can stabilise and, in compensated disease, patients may remain well for many years with proper management.

What is the difference between compensated and decompensated cirrhosis?

Compensated cirrhosis means the liver still performs its functions and there are no complications. Decompensation is defined by the appearance of ascites, variceal bleeding, hepatic encephalopathy or jaundice, and marks a clear change in prognosis. Preventing decompensation is the central aim of treatment.

Does every patient need a screening endoscopy for varices?

No. Under the Baveno VII criteria, patients with compensated advanced chronic liver disease whose liver stiffness is below 20 kPa and whose platelet count exceeds 150,000 have a very low probability of varices needing treatment, and endoscopy can be avoided in favour of annual monitoring.

Sources


Content last updated: September 2026 (14/09/2026).