Liver fibrosis results from chronic assault on the liver by alcohol abuse or by hepatitis B and C viruses. It is also seen in obesity or diabetes. It causes excessive fibrous scarring to appear in the liver tissue, which eventually disrupts the architecture of the liver and disrupts its functioning. Fibrosis itself does not cause symptoms, but severe scarring can lead to cirrhosis, which can cause symptoms. Treatment involves correcting the underlying disease or cause, when possible.

Fibrosis is the formation in the liver of an abnormally abundant amount of scar tissue, essentially made up of collagen fibers, which will gradually replace the liver tissue. It occurs when the liver is repeatedly or continuously damaged, and the liver tries to repair itself and replace damaged cells.

Indeed, after a single episode of lesions, even if they are severe, the liver often repairs itself by producing new liver cells and attaching them to the connective tissue matrix left by the liver cells when they die. However, if the lesions are repeated or continuous, the liver cells try to repair them, but these attempts result in the formation of scar tissue.

The resulting scar tissue replaces liver cells and, unlike liver cells, does not perform any function. On the contrary, it can distort the internal structure of the liver and interfere with blood circulation, restricting the blood supply to liver cells. Without sufficient blood supply, these cells die and more scar tissue is formed.

Fibrosis is sometimes reversible if the cause is quickly identified and corrected. However, after months or years of repeated or continuous injury, fibrosis becomes widespread and permanent. The scar tissue can then form bands in the liver, destroying the internal structure of the liver and impairing its ability to regenerate or function.

There are 5 stages of fibrosis:

• stage 0: absence of fibrosis, the liver is normal;
• stage 1: minimal fibrosis;
• stage 2: moderate fibrosis;
• stage 3: severe fibrosis;
• stage 4: cirrhosis, when there is an excessive amount of scar tissue throughout the liver.

Minimal and moderate fibrosis may regress when the cause of the fibrosis is treated. Severe fibrosis corresponds to a stage of sometimes very rapid transition to cirrhosis, but remains reversible. On the other hand, cirrhosis corresponds to an irreversible condition.

A variety of disorders and drugs can repeatedly or continuously damage the liver, resulting in fibrosis:

• chronic alcohol consumption;
• chronic viral hepatitis B and C;
• non-alcoholic fatty liver disease (NASH), that is, not caused by alcohol consumption. This usually occurs in people who are overweight, have diabetes or prediabetes and / or high levels of lipids and cholesterol in the blood;
• genetic diseases such as hemochromatosis;
• autoimmune diseases such as autoimmune hepatitis and autoimmune cholangiopathies;
• taking certain medications such as paracetamol;
• certain chemotherapy drugs;
• certain exposures to toxic products such as carbon tetrachloride and organic solvents.

Fibrosis of the liver is also seen in obesity or diabetes and can develop more quickly when it is due to obstruction of the bile ducts.

Fibrosis is a slow, silent process that does not cause symptoms.

On the other hand, symptoms can arise from the disease that causes the fibrosis. These symptoms include: 

• jaundice, that is, jaundice;
• varicose hemorrhage;
• ascites, which is a buildup of fluid in the abdomen;
• portosystemic encephalopathy.

In addition, when fibrosis progresses and results in cirrhosis, it can cause complications such as:

• portal hypertension (fibrosis deflects intrahepatic blood flow);
• life-threatening liver failure;
• primary liver cancer, etc.

No drug to date can effectively block scar tissue formation. This is why the management of patients with hepatic fibrosis consists in treating the cause, which generally makes it possible to stop or slow down the fibrosis, and to lead to an improvement or even to reverse certain fibrosis. This includes:

• administration of antiviral drugs to eradicate the hepatitis B or C virus if the person has chronic viral hepatitis;
• abstaining from alcohol consumption if the person has alcoholic liver disease;
• administration of drugs to flush out heavy metals if the person has iron overload (hemochromatosis) or Wilson’s disease that causes copper to build up;
• stopping any medication that may cause fibrosis;
• removal or dissolution of obstructions in the bile ducts;
• weight loss and control of blood sugar and lipid levels in people with non-alcoholic fatty liver disease.