[Jaepa]

They are to an extent. Cirrhosis is permanent. Other conditions such as fatty liver are reversible-ish.

The issue is that the liver is basically fully functional until after you’ve destroyed ~88% of it.

For a tortured analogy it’s a lot like a DB. Most of them time you’re well under your total capacity. Even short spikes in queue length aren’t an issue. But once you hit the tipping point there are cascading failures.

[skissane]

> Cirrhosis is permanent

Cirrhosis has been observed to reverse in some individuals. It is still permanent for most patients, and we shouldn’t give people with it false hope, but its reversal isn’t impossible. Most commonly cirrhosis reversal is observed after chronic viral hepatitis is cured by antiviral treatment. There are even a handful of clinical case reports of alcoholic cirrhosis reversing after extended abstinence from alcohol, even though that is a rather rare outcome. I remember reading a case report (sorry can’t find it right now), of a Japanese alcoholic diagnosed with liver cirrhosis, who then was severely disabled by a stroke, and had to be moved to a nursing home. He never drank again because he physically couldn’t drink without nursing staff assistance, and they weren’t going to give him any alcohol. Roughly 20 years later, his cirrhosis had disappeared. Of course, this is a rare outcome (he likely had favourable genetics, plus rarely does an alcoholic find relapse physically impossible), but it shows it can happen.

This is why there is a lot of hope that some of the liver disease drugs currently in the clinical pipeline may be able to reverse cirrhosis (and if not them, maybe their future successors). However, current trials are focusing on fibrosis not cirrhosis. And they run into the difficulty that what counts as cirrhosis seems reasonably clear in everyday clinical practice, but how to reliably detect its existence/progression/improvement/reversal to a clinical trial standard of certainty is difficult and a matter of dispute

(No I don’t have cirrhosis, as far as anyone knows, but my aunt had it-albeit asymptomatic, it was only discovered on autopsy after she suddenly and unexpectedly died from a cardiac arrest while asleep one night-which is actually very common, majority of people with liver disease die from heart disease before the liver disease kills them, or even causes any observable symptoms-but I do have intermittent hypochondria, and in some of my past hypochondriac episodes I have become rather obsessed with reading papers on this and related topics.)