Liver Fibrosis

By Stephen Holt, MD, PhD, FACP

• What is Liver Fibrosis?
• Causes
• Who is at Risk?
• Symptoms
• How is it Diagnosed?
• Treatment
• Alternative Treatments
• Suggested Articles

What is Liver Fibrosis?

Fibrosis of the liver is excessive accumulation of scar tissue that results from ongoing inflammation and liver cell death that occurs in most types of chronic liver diseases. Nodules, abnormal spherical areas of cells, form as dying liver cells are replaced by regenerating cells. This regeneration of cells causes the liver to become hard. Fibrosis refers to the accumulation of tough, fibrous scar tissue in the liver.

Causes

Fibrosis occurs when excessive scar tissue builds up faster than it can be broken down and removed from the liver. Chronic infection with hepatitis C or hepatitis B virus (HCV or HBV), heavy alcohol consumption, toxins, trauma or other factors can all lead to liver fibrosis. Only in rare instances is liver fibrosis the primary problem; more often, it is secondary to some other liver disease such as cirrhosis.

Normally, the body’s response to injury is the formation of scar tissue. In the case of fibrosis, the healing process goes haywire. When hepatocytes (functional liver cells) are injured due to a virus, alcohol, toxins, trauma or other factors, the immune system goes to work to repair the damage. During the fibrosis process, the injured hepatocytes cause substances to be released into the liver causing the buildup of the scar tissue.

Who is at Risk?

Risk factors are as follows:

• Chronic infection with hepatitis B or C virus
• Gender (fibrosis occurs more rapidly in men than in women)
• Age (people over 50)
• Compromised immune system (due to coinfection with HIV or use of immunosuppressive drugs after a liver transplant)
• Heavy alcohol consumption
• Fatty liver (steatosis)
• Insulin resistance (the condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to have its effects)

Symptoms

In the early stages, few people experience symptoms because the liver functions relatively well. Fibrosis is the initial stage of the formation of scar tissue in the liver. An individual may have no symptoms and live a normal, sometimes very active life, for decades, and remain unaware that he or she has liver disease.

As scar tissue builds up, due to inflammation and the continuance of liver injury, it connects with existing scar tissue, which can eventually disrupt the metabolic functions of the liver. If the disease progresses, it can lead to cirrhosis, a condition in which the liver is severely scarred, its blood flow is restricted, and its ability to function is impaired.

If poked, a healthy liver is very soft. A liver that has developed fibrosis is firmer, and if the condition progresses to cirrhosis, the liver can be almost rock-hard.

How is it Diagnosed?

Early fibrosis can be difficult to diagnosis because it is often asymptomatic. If a blood test indicates fibrosis of the liver, typically, a liver biopsy will be performed. A liver biopsy requires a needle to remove a small sample of liver tissue so that doctors can assess the extent of liver damage and stage the degree of fibrosis.

Several scales are used to stage fibrosis. One common classification is a scale from 0 to 4 where

• stage 0 indicates no fibrosis;
• stage 1 indicates enlargement of the portal areas by fibrosis;
• stage 2 indicates fibrosis extending out from the portal areas with rare bridges between portal areas;
• stage 3 indicates many bridges of fibrosis that link up portal and central areas of the liver; and
• stage 4 indicates cirrhosis.

The degree of fibrosis can be assessed as none, minimal, mild, moderate or severe.

Considered the “gold standard” for determining the extent of liver disease, several points of interest regarding liver biopsy should be considered. Liver biopsy is not always accurate and has several shortcomings. The procedure is invasive and not without potential complications such as bleeding and infection. At least 20 percent of patients have pain that requires medications after liver biopsy. Rare complications include puncture of another organ, infection, and bleeding. Significant bleeding after liver biopsy occurs in one out of 100 to one out of 1,000 cases, and deaths are reported in one out of 5,000 to one out of 10,000 cases.

Researchers have been seeking less invasive ways to diagnose liver disease, developing and testing clinical tools such as a highly sensitive imaging procedure called Magnetic Resonance Elastography (MRE) in which a special kind of mechanical energy called “shear waves” to probe the mechanical properties of tissue is used. MRE can measure elasticity – detecting abnormal hardening of liver tissue – sparing some patients the need for a biopsy and allowing physicians to begin intervention aimed at treating their disease before it progresses to cause irreversible damage.

Treatment

The process leading to cirrhosis can often be slowed and sometimes even halted. The liver has an amazing ability to regenerate itself once the underlying cause of the fibrosis is controlled or cured.

• Abstain from drinking alcohol (drinking alcohol may cause further liver damage)
• Treat any infections promptly (avoid people who are ill, use good hygiene by frequent hand washing, get vaccinated for hepatitis A and B, influenza and pneumonia)
• Eat a healthy, well balanced diet including lots of fruits and vegetables/avoid raw seafood (good nutrition is important to liver health). People with liver concerns should avoid eating raw seafood due to the risk of infection.
• Eat a low sodium/low fat diet (excess salt can cause the body to increase fluid retention in the abdomen and legs)
• If diagnosed with hepatitis, take medications to treat it which can slow disease progression and possibly reverse fibrosis
• Avoid inhaling toxic substances by wearing a protective mask
• Avoid the use of recreational drugs
• Use over the counter medications carefully avoid aspirin, ibuprofen, (Advil, Motrin, others) and naproxen (Aleve, others). When in doubt, consult a physician or pharmacist
• Get regular exercise and rest

Alternative Treatments

There are very few safe alternative methods for treating liver diseases. Some alternative treatments that have proven safe are milk thistle, SAMe and green tea. Unsafe alternative treatments that are known to cause liver damage are:

• Pennyroyal
• Comfrey
• Camphor
• Skullcap
• Chaparral
• Kava
• Ma-huang (a Chinese herb)

This information is for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

Suggested Articles

• How Green Tea Protects Against Liver Fibrosis
• Sulfasalazine’s Potential for Reversing Fibrosis
• Medical Marijuana, Alcoholism and Your Liver

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.