What is the difference between liver fibrosis and liver cirrhosis? Can it be cured?

Author: Ye Qing, deputy chief physician of Tianjin Third Central Hospital

Reviewer: Xiang Huiling, Chief Physician, Tianjin Third Central Hospital

Many patients who visit the gastroenterology department may have such doubts: "The doctor said I have 'liver fibrosis'. What is 'fibrosis'? Can it be cured?" "I often heard the term 'liver cirrhosis' before, so what is the difference between the 'liver fibrosis' I have and 'liver cirrhosis'?" "How long can I live if I have 'liver fibrosis'?" Let's talk about "liver fibrosis" today.

1. What is liver fibrosis? How is it different from liver cirrhosis?

Liver fibrosis refers to the diffuse excessive deposition and abnormal distribution of the liver's extracellular matrix (i.e. collagen, glycoproteins, proteoglycans, etc.). It is the liver's pathological repair response to chronic damage. It is a key step in the development of various chronic liver diseases to cirrhosis and an important link affecting the prognosis of chronic liver diseases [1].

In layman's terms, liver fibrosis is a repair response of the liver after various chronic liver diseases (such as viral hepatitis) or alcohol, fat deposition, etc. damage the liver. For example, just as scars form after our skin is injured, after the liver suffers continuous damage, normal liver cells will be replaced by "scars" and gradually form fibrosis. If liver fibrosis continues to develop, it will enter the stage of cirrhosis. Therefore, it can be understood that liver fibrosis is an intermediate step to cirrhosis.

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2. Is liver fibrosis reversible?

Liver fibrosis is histologically reversible, but once it progresses to the stage of cirrhosis it is difficult to reverse.

Some scholars believe that preventing and treating liver fibrosis can cure most chronic liver diseases. Therefore, effectively controlling liver fibrosis can prevent most chronic liver diseases from further developing into cirrhosis, liver failure and liver cancer.

3. How to diagnose liver fibrosis?

1. Pathological diagnosis Pathological examination of liver tissue is the "gold standard" for diagnosing liver fibrosis. It can be divided into 5 stages according to the degree of fibrosis: stage 0 represents no fibrosis; stage 1 represents fibrous expansion of the portal area, but no fibrous septa; stage 2 represents fibrous expansion of the portal area, with a few fibrous septa; stage 3 represents the formation of many fibrous septa, but no sclerotic nodules; stage 4 represents cirrhosis. From this point of view, by stage 4, it has entered the stage of cirrhosis.

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2. Blood biochemical indicators At present, there is still a lack of serum-specific diagnostic indicators for liver fibrosis. The four commonly used liver fibrosis tests (extracellular matrix components, namely hyaluronic acid, type III procollagen peptide, type IV collagen and laminin) can reflect the occurrence of liver fibrosis. Combined detection models are also used clinically to improve the diagnostic value. At present, the simpler models with clinical application value are APRI (aspartate aminotransferase and platelet ratio index) and FIB-4 (liver fibrosis 4-factor index). These two non-invasive assessment models can well reflect the degree of liver fibrosis. Of course, professional doctors are still needed to evaluate and judge. The new fibrosis detection indicator chitinase 3-like protein 1 has also begun to receive more and more attention. This indicator can predict moderate and severe liver fibrosis in patients with normal or slightly elevated alanine aminotransferase.

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3. Imaging evaluation Conventional ultrasound, CT, and magnetic resonance imaging are limited to the diagnosis of severe liver fibrosis, cirrhosis, and liver masses, and are of little significance for the diagnosis and staging of early liver fibrosis. Currently, liver stiffness measurement is the most commonly used clinical method to assess the degree of liver fibrosis. Liver stiffness measurement is a liver transient elastic imaging technology that can well reflect liver stiffness and assess the degree of liver fibrosis and cirrhosis. Of course, the thresholds for liver fibrosis of different causes are different and need to be judged by professional doctors.

4. How to treat liver fibrosis?

Like most diseases, early diagnosis and early treatment are particularly important for the treatment of liver fibrosis, which can help alleviate, reverse or even cure liver fibrosis.

1. Etiological treatment The treatment of liver fibrosis starts with etiological treatment. Quitting drinking, effectively inhibiting and eliminating chronic hepatitis viruses, controlling weight for patients with non-alcoholic fatty liver disease and improving related metabolic disorders, etc. These treatment measures targeting the etiology can reduce continuous liver damage and promote the repair of fibrotic liver tissue. After etiological treatment, liver fibrosis and even some cirrhosis patients can reverse liver fibrosis.

2. Anti-liver fibrosis treatment Chronic inflammatory response is the prerequisite for the formation of fibrosis and the driving force for the progression of fibrosis. Therefore, inhibiting liver inflammatory response, protecting liver cells and anti-oxidation are important measures for anti-liver fibrosis treatment. Studies have shown that some Chinese patent medicines have certain anti-liver fibrosis effects and have been widely used in clinical practice, such as Fuzheng Huayu Capsules, Anluo Huaxian Pills, Fufang Biejia Ruangan Tablets, Ganshuang Granules, etc.

It should be noted that the occurrence and development of liver fibrosis is a slow process, and its reversal also takes a long time. Therefore, the dosing cycle and observation course of anti-liver fibrosis drug treatment should be no less than 12 months, or even longer. The doctor will develop an individualized plan based on the patient's specific situation.

In short, liver fibrosis can be completely reversed by finding the cause and early diagnosis and treatment. Only by taking care of your liver can you have a better life!

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References

[1] Chinese Society of Hepatology, Chinese Society of Gastroenterology, Chinese Society of Infectious Diseases. Consensus on the diagnosis and treatment of liver fibrosis (2019) [J]. Chinese Journal of Hepatology, 2019, 27(9): 657-667.