There are different causes of cirrhosis, but the most common causes in the UK are drinking excessive amounts of alcohol and getting a hepatitis C infection.
Alcohol-related cirrhosis
The liver breaks down toxins (poisons), such as alcohol, but too much alcohol can damage the cells of the liver and cause it to scar. Men who drink more than 21 units of alcohol a week and women who drink more than 14 units of alcohol a week are considered to be drinking too much.
Read more about how to track your drinking.
If you're a heavy drinker, your chances of developing cirrhosis are increased. However, it's important to realise that cirrhosis of the liver isn't just a condition that affects people who are dependent on alcohol (alcoholics). If you're a heavy social drinker, you can also develop cirrhosis.
Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking. Some people are more susceptible to liver cell damage than others. The reasons for this are unknown.
Women who drink heavily are more susceptible to liver damage than men, partly because of their different body size and build.
People who drink excessively and continue to drink heavily develop cirrhosis in three separate stages. These are described below.
- The first stage of alcohol-related liver disease is known as ‘fatty liver’, which almost all excessive drinkers develop. It is a side effect of the liver breaking alcohol down. It disappears when you drink less.
- The second stage of alcohol-related liver disease is alcoholic hepatitis. Around 20-30% of people who continue to drink heavily develop alcoholic hepatitis. During this stage, the liver becomes inflamed. If alcoholic hepatitis deteriorates into its most extreme form (liver failure) it can lead to death.
- Around 10% of heavy drinkers go on to develop cirrhosis, which is the third stage of alcohol-related liver disease.
This risk of developing cirrhosis, along with the risk of alcoholic hepatitis, is one of the main reasons the government recommends that men shouldn't regularly drink more than 3-4 units of alcohol a day, and women shouldn't drink more than 2-3 units of alcohol a day.
Hepatitis-related cirrhosis
Hepatitis is an infection that's carried in the blood. It can cause liver damage which, over time, may develop into cirrhosis. It's caused by the hepatitis C virus and is one of the most common causes of cirrhosis in the UK.
Two other forms of the infection, hepatitis B and D, can also cause cirrhosis.
A person who was born in an area of the world with a high prevalence of hepatitis B and C, such as parts of South Asia or Africa, may have acquired one of them in early childhood. In many of these cases, they are unaware of the development of cirrhosis (which can occur slowly over 10-30 years) as they often feel fine until the symptoms of cirrhosis and liver failure develop.
Non-alcoholic steatohepatitis
Non-alcoholic steatohepatitis (NASH) is a severe liver condition that can lead to cirrhosis. As with alcohol-related liver disease, the early stage of NASH is the build-up of excess fat in the liver. This fat is associated with inflammation and scarring, which could lead to cirrhosis.
NASH can develop in people who are obese, have diabetes, have high levels of fat in the blood (high cholesterol) and high blood pressure. Most people with NASH feel well and aren't aware that they have a problem.
Other causes
A number of other conditions and inherited diseases can prevent the liver functioning healthily and can lead to cirrhosis. These include:
- autoimmune liver disease – the immune system usually makes antibodies to attack bacteria and viruses; however, if you have an autoimmune disease, such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis (PSC), your immune system will make antibodies that attack healthy organs of the body
- some rare, genetic conditions – such as haemochromatosis (a build-up of iron in the liver and other parts of the body) and Wilson's disease (a build-up of copper in the liver and other parts of the body)
- any condition that causes the bile ducts to become blocked – such as cancer of the bile ducts or cancer of the pancreas
- Budd-Chiari syndrome – caused by blood clots blocking the veins that carry blood from the liver
In less common cases, the use of certain medications, such as amiodarone and methotrexate, can also cause cirrhosis.
Cirrhosis and diabetes
If you have type 2 diabetes and you develop cirrhosis, your diabetes may get worse. This is because cirrhosis can increase your resistance to insulin (a hormone that the body produces to control blood sugar levels). If you have diabetes and you develop cirrhosis, you should discuss the implications with your GP.
