Malik HZ, Marshall C, Al-Khazraji A, Idriss R. Muscle cramps in liver cirrhosis: Pathophysiology, burden, and emerging therapeutic approaches. World J Hepatol 2026; 18(5): 117010 [DOI: 10.4254/wjh.v18.i5.117010]
Corresponding Author of This Article
Ahmed Al-Khazraji, MD, Assistant Professor, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, United States. aa2758@njms.rutgers.edu
Research Domain of This Article
Gastroenterology & Hepatology
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Minireviews
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Malik HZ, Marshall C, Al-Khazraji A, Idriss R. Muscle cramps in liver cirrhosis: Pathophysiology, burden, and emerging therapeutic approaches. World J Hepatol 2026; 18(5): 117010 [DOI: 10.4254/wjh.v18.i5.117010]
World J Hepatol. May 27, 2026; 18(5): 117010 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.117010
Muscle cramps in liver cirrhosis: Pathophysiology, burden, and emerging therapeutic approaches
Hajira Z Malik, Caitlin Marshall, Ahmed Al-Khazraji, Rajab Idriss
Hajira Z Malik, Department of Internal Medicine, University of South Alabama College of Medicine, Mobile, AL 36606, United States
Caitlin Marshall, Rajab Idriss, Division of Gastroenterology and Hepatology, University of South Alabama College of Medicine, Mobile, AL 36606, United States
Ahmed Al-Khazraji, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Co-corresponding authors: Ahmed Al-Khazraji and Rajab Idriss.
Author contributions: Malik HZ contributed to the data and searching articles; Malik HZ, Marshall C, and Idriss R contributed to writing the original draft; Al-Khazraji A and Rajab Idriss contributed to reviewing and editing and contributed equally to this manuscript as co-corresponding authors; Al-Khazraji A contributed to project administration and supervision; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Corresponding author: Ahmed Al-Khazraji, MD, Assistant Professor, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, United States. aa2758@njms.rutgers.edu
Received: November 26, 2025 Revised: January 5, 2026 Accepted: February 9, 2026 Published online: May 27, 2026 Processing time: 181 Days and 11.3 Hours
Abstract
Muscle cramps are a frequent yet underrecognized complication in patients with liver cirrhosis, affecting up to 88% of this population and contributing substantially to morbidity and impaired quality of life. These painful, involuntary contractions are often overlooked due to the clinical emphasis on life-threatening complications of cirrhosis despite their independent association with poor functional status, sleep disturbance, and psychosocial decline. The precise pathophysiology remains incompletely understood, but proposed mechanisms include peripheral nerve hyperexcitability from oxidative stress, altered amino acid and energy metabolism, and deficiencies in taurine, carnitine, and branched-chain amino acids. Several therapeutic strategies have been explored with variable efficacy. Small clinical studies have demonstrated benefit from taurine, L-carnitine, branched-chain amino acids, intravenous albumin, and selected muscle relaxants while evidence for quinine, vitamin E, and zinc remains limited or conflicting. Although these interventions show promise in reducing cramp frequency, severity, and duration, most are supported only by small trials and case series with no definitive guideline-directed therapy currently available. This review highlighted the prevalence, pathophysiology, and therapeutic landscape of muscle cramps in cirrhosis, underscoring the urgent need for larger randomized controlled trials to validate existing strategies and identify novel treatments. Addressing this overlooked symptom could significantly improve quality of life for patients with advanced liver disease.
Core Tip: Muscle cramps are an overlooked but highly debilitating complication of liver cirrhosis, affecting up to 88% of patients and severely impairing quality of life. Despite their prevalence, cramps remain undertreated due to limited clinician awareness and the absence of guideline-directed therapy. This review synthesized current evidence on the pathophysiology, including nerve hyperexcitability, altered amino acid metabolism, and energy depletion, and highlighted emerging therapeutic options such as taurine, L-carnitine, branched-chain amino acids, muscle relaxants, and albumin infusion. By summarizing available data and identifying gaps requiring larger randomized trials, this review provided clinicians with a practical framework to better recognize, evaluate, and manage muscle cramps in cirrhosis.
