Everything You Need To Know About Liver Fibrosis

Liver fibrosis is the buildup of scar tissue in the liver, the organ that helps you digest food, store energy, and remove toxins.

Liver fibrosis occurs as the organ tries to repair itself from inflammation or injury.

Early diagnosis and treatment of the underlying cause can help reverse liver fibrosis, slow its progression, or prevent it from developing into cirrhosis (severe scarring).

Liver fibrosis occurs due to chronic (long-term) inflammation or repeated damage. When the liver tries to heal, collagen and other proteins build up in the cells, forming scar tissue that can change the liver’s structure and lower its ability to heal and function properly.

Several conditions and factors can cause liver fibrosis, including: 

• Nonalcoholic fatty liver disease (MAFLD): This condition occurs due to a buildup of fat in the liver. Excess fat triggers liver swelling, damaging liver cells and prompting scar formation.
• Metabolic dysfunction-associated steatohepatitis (MASH): This condition can happen when untreated MAFLD worsens, causing cirrhosis, inflammation, and liver damage.
• Chronic alcohol use: Excessive or long-term heavy drinking damages liver cells and triggers inflammation that leads to scarring. This is a leading cause of liver fibrosis worldwide.
• Viral hepatitis: Hepatitis B and C infections can cause chronic liver swelling, gradually leading to fibrosis.
• Autoimmune hepatitis: This is when the body’s immune system mistakenly attacks liver cells, leading to inflammation and scarring. 
• Hemochromatosis: This genetic condition causes excess iron buildup in the body, which can accumulate in the liver, leading to tissue damage and fibrosis.
• Wilson disease: This rare genetic disorder causes excess copper to build up in the liver, leading to liver damage and scar tissue formation.
• Biliary diseases: These conditions affect the flow of bile (a liquid that helps with digestion) in the liver. Primary biliary cholangitis can cause long-term inflammation and fibrosis.
• Certain medications: Long-term or excessive use of certain medications, such as Tylenol (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen), anabolic steroids (synthetic testosterone), some antibiotics, and immunosuppressants (medicine that weakens the immune system) like Rheumatrex (methotrexate), can injure the liver and lead to fibrosis.

Risk Factors

Not everyone with liver injury or disease will develop fibrosis.

Certain risk factors can increase the likelihood of developing liver fibrosis:

• Chronic alcohol use: Long-term heavy drinking can cause liver damage and increase the likelihood of fibrosis.
• Smoking: This can contribute to liver inflammation, worsening liver damage over time.
• Obesity: Extra body weight increases the risk of fatty liver disease, which can cause inflammation that scars the liver. 
• Diabetes and metabolic syndrome: These conditions raise the likelihood of developing fatty liver disease and can accelerate fibrosis.
• Repeated exposure to environmental toxins: Substances such as lead, cadmium, and polychlorinated biphenyls (PCBs) can damage the liver and promote fibrosis.
• Age: Adults aged 35-64 are more likely to develop liver fibrosis than children and younger adults.

Liver fibrosis typically develops slowly and doesn’t cause symptoms in its early stages. As the condition progresses and the liver gets more damaged and scarred, it cannot function properly.

Common symptoms of advanced liver fibrosis include:

• Fatigue 
• Loss of appetite 
• Nausea
• Abdominal pain
• Unintended weight loss
• Severe itchiness 
• Spider veins (blood vessels on the skin that look like spiders)

As scarring worsens, you may experience other symptoms and complications, such as:

• Jaundice (yellowing of the skin and whites of the eyes) 
• Easy bruising and bleeding
• Painful fluid buildup and swelling in the abdomen and legs 
• Hepatic encephalopathy (confusion or disorientation as toxins build in the brain)

A healthcare provider will review your medical history and perform a physical exam and diagnostic tests to diagnose liver fibrosis. Since early liver fibrosis doesn’t typically have symptoms, healthcare providers rely on several diagnostic tests to assess liver health and determine the extent of fibrosis. 

These tests may include:

• Blood tests: Blood tests can measure levels of liver enzymes, proteins that help protect the liver. Higher liver enzymes could be a sign of liver damage. Some tests, like liver function tests, check whether the liver is working properly and look for signs that point to fibrosis or liver disease.
• Imaging tests: These tests, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), can help get a better view of the liver, measure its size, and look for signs of fibrosis.
• Elastography: This imaging test measures the stiffness of the liver. During the test, a device sends vibration waves through the liver. The speed of the waves helps determine its stiffness, with faster waves meaning a stiffer liver. Generally, the stiffer a liver is, the more severe its fibrosis. 
• Liver biopsy: Providers take a small sample of liver tissue and examine it under a microscope to determine the degree of scarring. Although a biopsy is the primary way to diagnose liver fibrosis, it carries risks like bleeding, so providers typically use it only when other methods haven’t worked.

When To See a Healthcare Provider

If you have risk factors like chronic alcohol use, obesity, or diabetes, it’s a good idea to monitor your liver health through routine checkups.

See a healthcare provider if you experience vague, early signs of liver fibrosis, such as: 

• Fatigue
• Abdominal discomfort or pain
• Poor appetite
• Unintentional weight loss
• Spider veins

Seek immediate medical attention if you experience more severe symptoms, such as:

• Severe abdominal pain
• Confusion or difficulty concentrating 
• Vomiting blood (may look like coffee grounds) 
• Black stool (poop) 
• Jaundice
• Fever

Liver fibrosis is sometimes reversible, especially when found and treated early. The goal of treatment is to stop or slow fibrosis progression, manage symptoms, and address or prevent complications. With advanced fibrosis or cirrhosis, liver damage is permanent, but treatment can help prevent further scarring and improve quality of life. 

The most important step in managing liver fibrosis is identifying and treating the condition causing the liver damage. There are no specific United States Food and Drug Administration (FDA)-approved medications for liver fibrosis. Instead, your healthcare provider will recommend or prescribe treatment focusing on addressing the underlying cause of liver fibrosis.

Medications may include:

• Antiviral medications: These help eliminate the hepatitis B or C virus in people with chronic viral hepatitis.
• Chelation therapy: This medication binds to and removes excess iron or copper from the body, helping prevent further liver damage in conditions like hemochromatosis and Wilson disease.
• Corticosteroids: Short-term use of oral corticosteroids can help reduce liver inflammation. 
• Weight management: For those with MAFLD or MASH, losing weight can help improve liver health.
• Avoidance of alcohol: Not drinking alcohol can prevent further liver damage. 

A liver transplant may be the only remaining treatment option for advanced scarring or liver failure. A liver transplant involves removing an injured or diseased liver and replacing it with a portion of or a whole liver from a donor.

Being proactive about your liver health can help lower your risk of or prevent liver fibrosis.

Ways to lower your risk of liver fibrosis include:

• Limit alcohol consumption: Stopping or significantly reducing alcohol intake can help protect your liver. People with existing liver disease should completely abstain from alcohol. 
• Maintain a healthy weight: Obesity increases the risk of developing MAFLD and MASH, both of which can lead to fibrosis. Staying at the optimal weight you and your provider discussed, adopting a balanced diet, and staying active can help you maintain a healthy weight. 
• Follow a liver-friendly diet: A nutrient-rich diet supports overall liver function and can prevent conditions that lead to fibrosis. Eat plenty of fruits, vegetables, whole grains, healthy fats, and lean proteins, and limit your intake of processed foods, saturated fats, and refined carbohydrates. 
• Get vaccinated: Hepatitis A and B vaccines protect against these viral infections that can damage the liver.
• Drink coffee: Research suggests regular coffee consumption—about 2-3 cups daily—may help protect against liver fibrosis and cirrhosis by reducing inflammation. However, more research is needed to confirm these findings.
• Use medications wisely: Take prescription and over-the-counter (OTC) medications only as directed, and never combine medications with alcohol. 
• Avoid toxin exposure: Minimize contact with chemicals like cleaning products, insecticides, and aerosol products. Use protective gear when handling potentially harmful substances.
• Manage chronic conditions: Following your treatment plan for diabetes, high cholesterol, and metabolic syndrome can reduce the risk of liver damage and subsequent fibrosis.
• Get regular checkups: Routine medical visits allow for early detection of liver problems through blood tests and other screening methods, especially if you have risk factors.

Liver fibrosis occurs when scar tissue accumulates in the liver in response to chronic inflammation or injury.

Early detection and treatment of the underlying cause of liver fibrosis can help slow its progression and, in some cases, even reverse some liver damage.

Avoiding alcohol, managing your weight, eating a balanced diet, and staying up to date on your hepatitis vaccines can lower your risk of liver fibrosis.