Liver fibrosis - what is it and how to treat the disease
Liver fibrosis is an overgrowth of connective tissue that occurs due to excessive accumulation of extracellular matrix proteins (the basis of connective tissue) in the organ. The causes of the disease are chronic liver damage (hepatitis C or B and other pathologies of the organ, alcohol abuse). Fibrosis occurs when connective tissue builds up faster than it breaks down. The accumulation of ECM proteins changes the structure of the liver, which leads to fibrosis, and subsequently to cirrhosis, liver failure and portal hypertension. Separately, cardiac fibrosis of the liver, which is a consequence of chronic heart failure, is distinguished.
Degrees (stages) of liver fibrosis, symptoms of the disease
Classification of liver fibrosis:
- Noncirrhotic portal fibrosis in the form of three clinical forms - intrahepatic fibrosis, sclerosis of the portal and splenic veins, thrombosis of the portal and splenic veins.
- Simmers fibrosis (periportal fibrosis) is a complication of schistosomiasis.
- Congenital fibrosis is a hereditary disease.
Several scales are used to assess fibrosis. One of the most popular evaluation systems is the METAVIR scale. Doctors determine the degree of damage after taking a biopsy (a sample of liver tissue). The generally accepted classification is a scoring system from 0 to 4, where 0 indicates the absence of fibrosis.
Degrees (stages) of liver fibrosis:
- minimal;
- moderate;
- severe (cirrhosis).
It should be taken into account that a liver biopsy is an invasive procedure with possible complications (bleeding, infectious process, puncture of a nearby organ). At the same time, the biopsy does not allow determining the degree of liver damage with sufficient accuracy. Scientists are looking for less invasive ways to diagnose fibrosis. Currently, magnetic resonance elastography is successfully used, which allows to assess the elasticity of tissues and detect abnormal seals, saving patients from the need for a biopsy.
In the initial stages of the disease, it is asymptomatic. Fibrosis is characterized by a slow development, so the symptoms of liver fibrosis appear several years after the onset of the disease:
- poor appetite;
- dyspepsia;
- nausea;
- weakness, fatigue;
- pains in the right side.
Treatment of liver fibrosis
The liver has an amazing ability to regenerate. That is why timely treatment of fibrosis and control of liver condition is so important. Adequate therapy and giving up bad habits will stop the development of fibrosis and avoid complications.
Complex treatment of liver fibrosis includes:
- Elimination of the causative agent.
- Complete refusal to drink alcohol.
- Carrying out preventive measures to protect against infection with infectious diseases (you should avoid contact with sick people, observe hygiene (wash your hands more often), get vaccinated against hepatitis A and B, influenza, pneumonia in a timely manner).
- Adherence to a balanced diet with liver fibrosis (sufficient amount of fruits and vegetables, low-fat products). It is advisable not to use raw seafood because of the risk of infection.
- Rejection of hepatotoxic drugs.
- Taking medications that slow down the development of the disease.
If the diagnosis of liver fibrosis is made, the doctor prescribes drugs for treatment. There are no standards in the treatment of liver fibrosis. Since inflammation precedes and contributes to the progression of the disease, anti-inflammatory drugs are prescribed. Corticosteroids are indicated only for the treatment of liver fibrosis in patients with autoimmune hepatitis and acute alcoholic hepatitis. Antioxidants protect hepatocytes (liver cells) from apoptosis. Renin-angiotensin inhibitors are widely used as antifibrotic agents in patients with chronic kidney and cardiovascular diseases. Previous studies of the use of drugs of this group in patients with hepatitis C gave positive results. According to some data, taking hepatoprotectors slightly reduces the progression of fibrosis.
Complications of liver fibrosis, prognosis
Compared to cirrhosis, liver fibrosis proceeds more favorably. Complications of fibrosis - liver cirrhosis, liver failure, portal hypertension syndrome.
For liver fibrosis, the prognosis depends on the type and stage of the disease. Usually, fibrosis does not progress linearly over time. The period of progression from stage zero to stage two may be longer than from stage three to stage four. The most severe course and unfavorable prognosis in schistosomiasis. Mortality in fibrosis caused by schistosomiasis is about 8%. With congenital fibrosis, the prognosis is more favorable. With non-cirrhotic portal fibrosis, the prognosis depends on the patient's age, gender, and the presence of immunodeficiency conditions.
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