Evidence supporting the use of: Vitamin E (mixed alpha-tocopherol)
For the health condition: Cirrhosis of the Liver

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Vitamin E, especially in the form of mixed tocopherols including alpha-tocopherol, has been investigated for its potential role in the treatment of liver cirrhosis, particularly nonalcoholic steatohepatitis (NASH)-related cirrhosis. The rationale stems from Vitamin E’s antioxidant properties, as oxidative stress is implicated in the progression of liver injury and fibrosis. Several randomized controlled trials, most notably the PIVENS trial, have demonstrated that Vitamin E supplementation (800 IU/day) can improve liver histology in non-cirrhotic NASH patients, reducing inflammation and steatosis. However, the evidence for established cirrhosis (fibrosis stage F4) is far less robust. Current guidelines, such as those from the American Association for the Study of Liver Diseases (AASLD), recommend considering Vitamin E in non-diabetic adults with biopsy-proven NASH, but do not recommend it specifically for cirrhosis due to insufficient evidence of benefit in this subgroup.

There is limited to no high-quality data supporting Vitamin E's efficacy in reversing or significantly improving advanced cirrhosis from any etiology, including alcoholic or viral causes. Most clinical trials exclude patients with decompensated cirrhosis due to safety concerns and lack of demonstrated benefit. In summary, while there is scientific exploration and some positive findings for early-stage NASH, the evidence for Vitamin E as a therapy for established cirrhosis is weak and does not justify routine use.

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