Initial treatment for primary biliary cirrhosis is aimed at relieving symptoms. Vitamin replacement therapy, calcium supplements, and drugs to treat itching are usually prescribed.
A specific treatment that stops or reverses the progression of primary biliary cirrhosis has not been found. However, medication prescribed during the early stage of the disease may slow liver damage.
Ursodiol (Actigall). Ursodiol is the only drug approved by the U.S. Food and Drug Administration for the treatment of primary biliary cirrhosis. Ursodiol assists the liver in moving bile through the ducts to the gallbladder and small intestine. Studies have shown that ursodiol prescribed early in the disease improves liver function, slowing the time it takes to progress to liver failure and the need for a liver transplant.
Researchers are studying the effects of sev-eral other medications on the progression of primary biliary cirrhosis. To date, none have shown the positive effects of ursodiol.
Treatment for Cirrhosis and Its Complications
When the disease progresses to cirrhosis, the goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for people who have cirrhosis with complications.
Eating a nutritious diet. Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If fluid overload develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement either for drinking or administration with a nasogastric tube—a tiny tube inserted through the nose and throat that reaches into the stomach.
Avoiding alcohol and other substances. People with primary biliary cirrhosis are encouraged not to consume alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medications—prescription and over-the-counter—can affect liver function, a doctor should be consulted before taking them.
Treatment for cirrhosis also addresses specific complications. For edema and ascites, the doctor may recommend diuretics—medications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites requires intravenous (IV) antibiotics.
The doctor may prescribe a beta-blocker or nitrate for portal hypertension, which can lower the pressure in the varices and reduce the risk of bleeding. Gastrointestinal bleed-ing requires an immediate upper endoscopy to look for esophageal varices. The doctor may perform a band-ligation using a special device to compress the varices and stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes.
Hepatic encephalopathy is treated by cleans-ing the bowel with lactulose—a laxative given orally or in enemas. Antibiotics are added to the treatment if necessary. Patients may be asked to reduce dietary protein intake. The condition may improve as other complications of cirrhosis are controlled.
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