The Treatment of Hepatic Fibrosis: Reversal of the Underlying Disease Process.

Cirrhosis is considered an irreversible end stage of all liver diseases. Current knowledge indicates that fibrosis is part of the liver repair process, which is dynamic. Understanding this repair process will provide better approaches to halt, ameliorate, or reverse fibrosis. The diagnosis of cirrhosis is currently established by liver biopsy and in most advanced cases can be confirmed by imaging. Liver biopsy remains the gold standard but has several limitations: sampling error, size of the biopsy, and both inter- and intra-observer inconsistencies. Hence, many patients can be inaccurately staged for the degree of fibrosis on their initial biopsy, as well as on subsequent re-examination. Although a decrease of 1 stage between consecutive biopsies may be a result of sampling error, the reduction from cirrhosis by at least 2 stages more likely represents a reversal of cirrhosis. There are several cases of reversal of cirrhosis reported in association with different liver diseases. The resolution of fibrosis in the majority of these diseases is related to successful treatment of the underlying etiology (eg, hepatitis B, hepatitis C, iron overload, Wilson disease, alcohol abstinence, metabolic syndrome in fatty liver disease, and decompression of biliary obstruction). The other important feature of reversal of cirrhosis is the successful control of inflammation (eg, autoimmune hepatitis, primary biliary cirrhosis, hepatitis B, C, and D).