Liver Fibrosis

Liver fibrosis is a stage of chronic disease where healthy tissue in your liver begins to change. Ongoing injury from various causes (like alcohol use, hepatitis or steatosis) triggers a scarring process. As your liver tries to heal, it produces tough, fibrous proteins — like collagen — around the damaged areas.

Over time, scar tissue builds up and begins to block blood flow. This increases pressure in your portal vein and reduces how well your liver works.

What are the stages of liver fibrosis?

The stages of liver fibrosis are:

1. Minimal fibrosis
2. Moderate fibrosis
3. Severe fibrosis
4. Cirrhosis

What are the signs and symptoms of liver fibrosis?

Liver fibrosis itself doesn’t cause any signs or symptoms until stage 4 (cirrhosis) develops. If you have cirrhosis, you may experience:

• Fatigue
• Fluid buildup in your abdominal (belly) cavity and/or legs
• Gastrointestinal (GI) bleeding
• Altered thinking

What causes fibrosis of the liver?

Liver fibrosis is a result of continuous inflammation in your liver over months or years. This is what happens when you have chronic liver disease.

Many things can cause chronic hepatitis, leading to fibrosis. Some of the most common causes include:

• Heavy alcohol use: Alcohol use disorder can lead to alcohol-induced hepatitis, where excessive drinking causes inflammation and damage to your liver.
• Metabolic dysfunction: This includes conditions like metabolic dysfunction-associated steatohepatitis (MASH), where fat buildup and inflammation harm liver function.
• Viral infections: Hepatitis B and C are common viral infections that directly attack your liver and can cause long-term damage.

Other causes include:

• Autoimmune diseases: Conditions like autoimmune hepatitis and primary sclerosing cholangitis occur when your immune system mistakenly attacks your liver or bile ducts.
• Cardiovascular diseases: Disorders like Budd-Chiari syndrome and right-sided heart failure can reduce blood flow from your liver, leading to congestion and damage.
• Chronic overexposure to toxic chemicals or drugs: Long-term exposure, including to certain medications, can inflame and damage your liver — a condition known as toxic hepatitis.
• Conditions that obstruct or stall bile flow: Blockages from biliary atresia or diseases that injure your bile ducts, like primary biliary cholangitis and primary sclerosing cholangitis, can block bile flow.
• Inherited metabolic disorders: Genetic conditions like hemochromatosis and Gaucher disease cause toxic substances to build up in your liver, eventually harming its function.

Complications of liver fibrosis

It takes many years for liver fibrosis to progress to cirrhosis. It’s slower for some people and faster for others. But when it reaches the later stages, the damage is no longer reversible. Over time, your liver function starts to decline. This has many side effects and is eventually life-threatening.

How doctors diagnose liver fibrosis

If your provider suspects liver disease, they’ll likely start with blood tests to check for liver stress. If results are abnormal, they may order imaging to look for damage.

Once your provider finds liver injury, they’ll try to figure out the amount of fibrosis. They may use certain blood tests (like FIB-4 or FibroSure^®). Or they may measure the “elasticity” of your liver. If you have cirrhosis, your liver will be stiff, not elastic. Your provider may measure elasticity using FibroScan^®, liver ultrasound with elasticity or MRI with elasticity.

Standard scans like ultrasound, CT or MRI can show early and late-stage disease, but not fibrosis, the middle stage. That requires enhanced imaging.

If these tests are inconclusive, a liver biopsy can diagnose liver fibrosis. This means your provider takes a small tissue sample from your liver and sends it to a lab. They can usually take the sample in a simple bedside procedure using a hollow needle. A pathologist in the lab will assess the sample for fibrosis.

How is liver fibrosis treated?

Treating liver fibrosis starts with treating the cause. If you can stop what’s damaging your liver, you can help slow, stop or reverse the scarring process. Depending on your condition, treatment may involve lifestyle changes, medications or procedures.

Common approaches include:

• Lifestyle changes: Losing weight, eating healthy, and limiting or avoiding alcohol can reduce liver stress and slow fibrosis.
• Medications: Your provider may prescribe antiviral drugs for hepatitis or other treatments for conditions like metabolic dysfunction or autoimmune liver disease.
• Managing complications: If fibrosis progresses to cirrhosis, treatment may focus on preventing or managing issues like fluid buildup, bleeding or liver failure.
• Liver transplant: In severe cases of liver failure, a liver transplant may be the only option.

Some conditions don’t have a direct treatment, but your provider can still help you manage symptoms and slow progression.

Can liver fibrosis be reversed?

Your liver has a built-in ability to bounce back from injury. In fact, it’s the only organ in your body that can grow back to full size from a small piece. These same regenerative powers can also reverse the process of fibrosis — but only if the process stops. Over time, even cirrhosis can be reversible for some people.

Can fibrosis of the liver be prevented?

Catching liver disease early is your best chance of preventing fibrosis. Since liver disease often doesn’t cause symptoms early on, regular wellness checkups are helpful to screen for it. It’s not always possible to prevent liver disease. But healthy lifestyle habits can help prevent some of the most common causes.