Interview with Dr. Mertens about liver cirrhosis
and how to reverse the damage

Is Your Liver at Risk? You might feel fine, but your liver could be silently deteriorating. This interview with a leading expert Prof. Joachim C. Mertens reveals the surprising early signs of liver cirrhosis, often hidden in lab results, not physical symptoms. Discover the major causes, from viral hepatitis to the growing threat of fatty liver disease, and learn the incredible truth: your liver has a powerful ability to heal. But only if you act in time. Don't wait for yellow eyes or a swollen abdomen—find out what you need to know now.

Peter Zombori: Hello everybody. Welcome to our medical talk. Today, we're talking about liver cirrhosis, and our doctor of choice for today's interview is Professor Mertens. Welcome. Thank you for taking the time.

Prof. Joachim Mertens: Thank you, Peter.

Peter Zombori: We'd like to jump right into it. One of the questions we hear quite frequently is: What are the first signs of liver cirrhosis? Can you help us with that?

Prof. Joachim Mertens: Most of the time, people will come to us because they show elevated liver values. So, many times, the first finding really is something in the lab, not something that you feel or something that you see, but most of the time it’s lab value that raises attention. Usually, that is the starting point of doing more tests, trying to figure out why the liver value is elevated, why certain lab values are out of range, and again leads to a diagnosis. Rarely, patients present with physical signs of advanced liver cirrhosis without prior lab abnormalities. When physical signs are present, they may include sudden yellowing of the skin, abdominal distension, or increased bleeding. However, these are usually indicators of advanced liver disease, which we aim to detect earlier through lab values.

Watch the full interview here:

Peter Zombori: Okay. But if, at the beginning of liver cirrhosis, there's no pain or visible symptoms, it's solely based on lab values, correct?

Prof. Joachim Mertens: That's primarily correct.

Peter Zombori: So, my next question was about the first signs, but that's redundant. You need lab work.

Prof. Joachim Mertens: Even with lab work, if you're not having regular checkups, patients might report right upper quadrant pain or pressure, fatigue, or yellowing of the eyes. This yellowing is often noticed by others before the patient. So, any of these signs, from less specific right upper quadrant pain to more specific signs like yellow eyes or changes in blood coagulation, warrant a professional checkup.

Peter Zombori: And what are the main causes of liver cirrhosis?

Prof. Joachim Mertens: It's important to understand that cirrhosis is the liver's almost universal response to damage. The liver, a normally smooth and highly organized organ, develops scar tissue over time when repeatedly damaged. This scarring eventually leads to cirrhosis.

Common causes of liver damage include viral hepatitis B and C, which are significant worldwide triggers. We're also seeing an increase in fatty liver disease, which can occur in both obese and slim individuals. Alcohol is another major factor in many countries. Rarer causes include genetic storage diseases, where the liver abnormally stores metabolites (this can be iron or others).

So, in summary, the main causes are viral hepatitis, fatty liver disease, alcohol, and genetic liver diseases.

Peter Zombori: Last question, because we want to keep these interviews concise. Can the liver heal? How?

Prof. Joachim Mertens: Yes, one of the very fantastic capabilities of the liver is that the liver heals really well. And the liver heals to a degree that, just a couple of years ago, we were not aware of the enormous capacity for healing. I've seen patients with end-stage liver cirrhosis, often caused by hepatitis C, and if you treated hepatitis C, you could really observe that patients would revert from liver cirrhosis to low degree of liver scarring.

If you remove the damaging agent, whether it's a virus, fat, alcohol, or other factors, the liver can often repair itself, not completely to normal, but significantly. Close surveillance is necessary.

Peter Zombori: But it needs a treatment and surveillance, basically. Or is it just a lifestyle change, and then it's all good?

Prof. Joachim Mertens: It needs close surveillance because liver cirrhosis doesn’t only come with the problem of liver failure but is also carries a substantial risk of liver cancer development. Regular monitoring is crucial. Removing the damaging agent doesn't guarantee complete healing, but it significantly increases the chances.

Peter Zombori: Okay. Thank you, Professor Mertens. I know you have a very busy schedule, as always, and I'd like to thank you for being with us and helping us understand the concept of liver cirrhosis treatment. Thank you very much.

Prof. Joachim Mertens: Thank you. It's been great. Thanks.