In liver fibrosis, the liver tissue gradually undergoes structural changes.
In the early stages of liver fibrosis, fat cells (lipocytes) and liver stellate cells (Ito cells) transform into collagen-producing cells. As a result, the amount of collagen produced increases, while at the same time less and less collagen is broken down. This leads to an increased accumulation of collagen fibers in the liver tissue and in the liver’s functional units, the hepatic sinusoids.
Collagen, which serves as the structural framework of connective tissue, is increasingly deposited within the liver’s internal structures. As liver fibrosis progresses, liver function may become increasingly impaired. The liver’s ability to function becomes progressively more limited until it eventually loses all function.
Liver fibrosis is not, in and of itself, a typical consequence of a single instance of liver damage or an infection. Instead, liver fibrosis can develop as a result of various underlying conditions. These include, among others:
- chronic viral hepatitis (commonly referred to as jaundice),
- fatty liver,
- toxic exposure (e.g., mold toxins or medications),
- liver congestion resulting from heart failure, or
- hemochromatosis (iron storage disease).
In addition, liver fibrosis in a very advanced stage can also progress to cirrhosis. This leads to a loss of liver function as a result of liver cirrhosis.
In liver fibrosis, liver function is already severely impaired © nmfotograf | AdobeStock
In the majority of cases, liver fibrosis is asymptomatic. Those affected therefore do not initially notice anything about the disease. The connective tissue changes in the liver therefore only become noticeable once the condition has progressed to the stage of liver cirrhosis. At that point, symptoms such as jaundice (icterus) or unpleasant itching of the skin may occur.
Some people also complain of nonspecific accompanying symptoms that often occur alongside liver fibrosis. These include, for example:
Using sonography (ultrasound), doctors can, for example, visualize structural changes in the liver.
Blood tests are also a proven method for detecting liver diseases. Affected individuals typically have elevated levels of collagen IV as well as higher levels of liver enzymes (aspartate aminotransferase, AST, and alanine aminotransferase, ALT) in their blood.
Liver fibrosis itself cannot be treated or reversed. This means that once liver tissue is damaged, it remains damaged. Therefore, the course of the disease
- primarily on the initial stage at the time of diagnosis and
- on the success of treatment for the underlying cause of the connective tissue remodeling.
In the best-case scenario, liver fibrosis is diagnosed early. In this case, treatment can halt the progression of the disease at an early stage.
Without treatment of the underlying cause, end-stage liver fibrosis will eventually progress to liver cirrhosis.
Treatment for liver fibrosis always targets the underlying disease. For example, viral hepatitis can be treated with medication, which can also halt liver fibrosis. However, drug treatment for liver fibrosis itself is not (yet) possible today.
In cases of advanced liver fibrosis, treatment is usually limited to managing symptoms. Although a cure is not possible, patients can maintain a certain quality of life. Common measures in such cases include, for example,
- a change in diet,
- more exercise, and
- minor surgical procedures to reroute the bile ducts.
A liver transplant is necessary in particularly severe and advanced cases.
To prevent liver fibrosis, you should first and foremost avoid alcohol.
Also be mindful of medications that can damage the liver when taken in large quantities. One of the best-known is acetaminophen. Furthermore, maintaining a healthy weight and getting vaccinated against hepatitis A and B can help prevent certain causes of liver fibrosis.
The liver is the most important metabolic organ in the human body. Its diagnosis and treatment should be entrusted to specialists in internal medicine who specialize in hepatology. They sometimes work in specialized liver treatment centers. These centers have the expertise and clinical experience necessary to ensure excellent care for patients.
Depending on the underlying condition, it may also be necessary to consult other specialists, such as those in
If a liver transplant is required, specialists in transplant medicine should be involved in the treatment of liver fibrosis.
What is liver fibrosis?
Liver fibrosis is a chronic liver disease in which liver tissue is replaced by connective tissue. This scarring results from repeated damage to liver cells, causing activated hepatic stellate cells to form scar tissue. Liver fibrosis can progress to cirrhosis if left untreated.
How does liver fibrosis develop?
Liver fibrosis is most commonly caused by chronic alcohol consumption, viral hepatitis, or other chronic liver diseases. Genetic factors also play a role in the development of the disease. As the disease progresses, hepatocytes are damaged and liver cells are replaced by connective tissue.
Is liver fibrosis curable?
A complete cure is not always possible, but regression of liver fibrosis is conceivable in the early stages. Studies on the regression of liver fibrosis show that partial regression can occur if the underlying cause is eliminated—for example, through treatment of viral hepatitis. Early treatment of liver fibrosis is crucial.
What treatments are available for liver fibrosis?
Treatment depends on the cause of the liver disease. Therapeutic approaches focus on abstaining from alcohol, antiviral treatment for infections, and targeted strategies to inhibit fibrosis. New findings from university medical centers and research teams are focused on developing future therapies that target activated cells and the extracellular matrix.
How is liver fibrosis diagnosed?
Diagnosis is made through clinical examination, laboratory tests, and imaging techniques. Histological data from a liver biopsy can assess the degree of scarring. Modern methods such as Acoustic Radiation Force Impulse allow for a non-invasive assessment of liver scarring. Close collaboration between hepatology and gastroenterology is crucial for further treatment.
