DEAR DR. ROACH: I am a 78-year-old woman who was diagnosed just one year ago with primary biliary cirrhosis, which is an autoimmune liver disease. It was determined that it took me many years to get to this stage, but I had no symptoms other than high liver enzymes from time to time (but not always). I am currently monitored for progression and still have very few symptoms.

When I mention this disease, my friends look at me with jaws dropped open and say they never knew I was a heavy drinker. I have never been a drinker. Though this is not a rare disease, most people have never heard of it, and when they hear the word “cirrhosis,” it is automatically associated with alcoholism. Perhaps you might explain to your readers that not all people with liver cirrhosis are alcoholics. — J.V.W.

ANSWER: Cirrhosis of the liver is the end stage of many different illnesses, all of which cause progressive destruction of the liver cells and cause fibrosis — a thickening or scarring — of the liver. Alcoholic liver disease is the single most common cause of cirrhosis referred for liver transplant, which may be why people tend to think of alcohol as the cause of all cirrhosis. The second leading cause is hepatitis C, a viral disease that is now curable. The third cause, as of this writing, non-alcoholic fatty liver disease, is very likely to be the leading cause in the next few years, as the liver can be damaged from the metabolic changes that occur in obesity, especially in people who have abnormally high blood sugar, both prediabetes and diabetes. Less-common causes include autoimmune hepatitis, hemochromatosis, primary biliary cholangitis (formerly called “primary biliary cirrhosis,” which you have) and primary sclerosing cholangitis. Alcohol, in reality, accounts for a minority of people with cirrhosis. However, drinking alcohol should be avoided by people with any kind of chronic liver disease, especially cirrhosis, since it damages liver cells.

Primary biliary cholangitis is, as you said, an autoimmune disease of the bile ducts of the liver. Most people have no symptoms early on. If people do have symptoms, they’re likely to be nonspecific symptoms like tiredness. Itching can be a clue to the involvement of the liver. Blood testing usually but not always shows elevations of common liver tests, especially the alkaline phosphatase. A specific blood test, antimitochondrial antibodies, makes the diagnosis very likely, though a liver biopsy is sometimes done to be sure.

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