Can Liver Fibrosis Be Reversed?

Liver fibrosis is an important health concern. While no universal treatment for liver fibrosis is available, treating the underlying cause can improve liver health and, in some instances, reverse the fibrosis. 

What is liver fibrosis and what causes it?

Liver fibrosis is when scar tissue builds up in the liver and replaces healthy tissue. This is a problem because it prevents the liver from functioning correctly and can block blood flow through the liver. 

Fibrosis is ultimately the wound healing response that develops in nearly all patients with chronic liver insults, albeit at varying rates. Interestingly, patients with acute liver diseases (e.g., fulminant hepatitis) do not develop scarring unless the injury turns chronic.

The main causes of hepatic fibrosis include:

• Alcoholic liver disease, caused by the excessive consumption of alcohol 

• Cholestatic liver diseases, where the flow of bile from the liver is impaired 

• Non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), which is often linked to obesity, type 2 diabetes, insulin resistance, or dyslipidemia 

• Viral hepatitis infections, including hepatitis B and C

Progression of liver fibrosis

Fibrosis is the first stage of liver scarring. 

If fibrosis is left untreated, it can progress to cirrhosis and hepatocellular carcinoma.

The progression of liver fibrosis can be classified and staged using several criteria, such as the METAVIR system. This is a semiquantitative classification system for chronic liver disease validated for various diseases such as hepatitis C. METAVIR score integrates fibrosis scored on a five-point scale, with activity (intensity of necroinflammation) scored on a four-point scale.

The METAVIR system has five stages and measures four levels of activity: 

Damage

F0: No fibrosis

F1: Portal fibrosis without septa

F2: Portal fibrosis with few septa

F3: Numerous septa without cirrhosis

F4: Cirrhosis

Activity

A0: No activity

A1: Mild activity

A2: Moderate activity

A3: Severe activity 

Can fibrosis of the liver be reversed?

Research has found that liver fibrosis may be reversed when the actual insult on the liver is removed, may it be antivirals for viral hepatitis or stopping alcohol intake in those with alcoholic steatohepatitis, granted the fibrosis is not extremely advanced.

However, the correlation between clinical outcomes and fibrosis reversal is yet to be elucidated, and the reversal may not necessarily translate into clinical benefit.

When does liver fibrosis truly become irreversible and why?

It’s not known at what exact point liver fibrosis becomes irreversible. 

It’s generally thought that liver fibrosis becomes irreversible when it progresses to cirrhosis. At that point, too much scar tissue has grown to compensate for the healthy tissue, and the liver can no longer regenerate sufficiently.

However, some research has found that even people with cirrhosis can experience a reversal of liver scarring to some extent.¹

How is liver fibrosis diagnosed?

Several methods can be used to diagnose fibrosis, including: 

Liver biopsy: A biopsy involves taking a tissue sample from the liver. This sample is then examined to check for any fibrosis or scarring. While liver biopsies are accurate and viewed as the gold standard, they are invasive. 

Vibration-controlled transient elastography: Sound waves are used to measure how stiff the liver tissue is. The stiffer it is, the more fibrosis there is. This method is less invasive than biopsy. 

What treatment can help the liver recover from damage?

Currently, no sole treatment for fibrosis itself is available, although some are in development. 

The key way to reverse liver fibrosis, prevent further fibrosis, and subsequently help the liver recover from damage is to treat the underlying cause. For example:

Alcoholic liver disease: When the fibrosis is related to excessive and chronic alcohol consumption, it’s recommended to stop drinking alcohol. 

Nonalcoholic steatohepatitis: People with nonalcoholic steatohepatitis should lose weight if they’re overweight, through lifestyle changes, and, if needed, weight loss surgery. 

Losing at least 3–5% of body weight can help reduce fat in the liver.² However, for patients with NASH or fibrosis, the weight loss goal is higher, around 7–10%. For patients with NASH and higher grade fibrosis, vitamin E or pioglitazone is also suggested for specific subsets of patients.

Gradual weight loss (about a kg per week (2lb)), generally by reducing calorie intake by around 30%, is recommended over rapid weight loss.³ Exercise is also recommended, as it’s been shown to be effective independent of weight loss.

Some people with NASH also need to control their blood sugar and lipid levels. 

Chronic viral hepatitis: Antiviral drugs are effective treatments for chronic viral hepatitis. Studies have found that between one-third and two-thirds of people experience a reduction in fibrosis after eradicating viral hepatitis.⁴

Another study of 120 patients with chronic hepatitis B, who were given the antiviral drug entecavir, found that 45% experienced fibrosis regression after 78 weeks.⁵

Autoimmune hepatitis: Studies indicate that immunosuppressive therapy can reduce liver fibrosis. 

Drug/medication-induced liver injury: In these cases, it’s important to stop taking the drugs that are thought to be causing the liver damage and fibrosis. 

Cholestatic liver disease: Removing or dissolving bile duct blockages can help reverse fibrosis. However, this may not be achievable in intrinsic diseases of the bile ducts such as PSC.

In all types of liver damage, dietary changes and physical activity are important. 

Dietary changes: 

People with chronic liver disease but without cirrhosis are often recommended to:

• Limit red meat

• Limit trans fats

• Limit processed and refined carbohydrates and high-fructose corn syrup 

• Focus on a high-fiber diet with plenty of fruits, vegetables, and whole grains. A Mediterranean style diet can be beneficial for this. 

• Reduce processed foods

Some research has found that silymarin and moderate amounts of coffee might have beneficial effects on liver fibrosis. However, the evidence is limited, particularly for silymarin. But a meta-analysis has demonstrated that in observational studies, coffee drinkers were less likely to develop cirrhosis. 

Physical activity: 

It’s recommended to get at least 150 minutes of moderate-intensity aerobic activity a week. Examples of moderate-intensity exercise include brisk walking, gardening, and biking slower than 10 miles per hour. 

Some studies have found that diet and exercise combined are more effective for liver health than either diet or exercise alone. 

How long does it take to reverse liver fibrosis?

It depends on what’s causing the liver fibrosis and how severe it is. Some studies have found that it can take years.⁶ It’s important to start treatment for liver fibrosis as soon as possible. 

The lowdown

Several medical conditions and lifestyle factors can cause liver fibrosis. If liver fibrosis is diagnosed when scar tissue is minimal, the damage may be reversed.

To help the liver recover and prevent progression to late-stage cirrhosis, it’s important to treat the underlying cause of fibrosis as soon as possible. 

People also ask

What can reverse liver fibrosis?

Treating the cause of the liver fibrosis can, in some cases, reverse liver fibrosis. Currently, no universal treatment that directly reverses liver fibrosis exists. 

What’s the best treatment for liver fibrosis?

The best treatment for liver fibrosis depends on the root cause. This may include abstaining from alcohol (for alcoholic liver disease), losing weight (for people who are overweight with non-alcoholic liver disease), following a healthy diet and undertaking physical activity, or taking antiviral medications (for chronic viral hepatitis). 

Does liver fibrosis always progress to cirrhosis?

Liver fibrosis does not always progress to cirrhosis. However, the risk of it progressing increases if the fibrosis is left untreated.