The rating of the degree of liver fibrosis is important to correct the discussion and establish the prospect of patients with inveterate liver disease . Until a few years ago it was necessary to perform a liver biopsy to study the degree of fibrosis . However , at present there are several non - invasive methods available to estimate the degree of fibrosis . These methods are imaging tests ( e.g. FIBROTAC ) , wide-eyed biochemical markers ( eg : Forns index ) , fibrogenesis marking ( TGFฮฒ1 , TIMP1 [ tissue paper inhibitor of metalloproteases 1 , tissue inhibitor of metalloproteases typecast 1 ] , PIIIP [ amino - terminus peptide of procollagen III ] and hyaluronic pane ) and more late elastography .
These method allow the degree of fibrosis to be estimated with fair to middling precision , although its usefulness for the evaluation of temperate changes is not well prove .
Currently , liver biopsy is indicated when , in increase to want to determine the degree of fibrosis , there are symptomatic doubts and precise entropy is necessitate on the type of inflammatory infiltrate ( for example , liver transplant patients ) .
Chronic hepatitis C is the most extensively studied disease . The virological reception maintained in patients who have experience IFN - ฮฑ and Virazole lessen the progression of fibrosis . Even a proportion of affected role with ripe fibrosis or cirrhosis of the liver can significantly annul the phase of fibrosis . Thus , a recent sketch show that patients treated with different pattern of IFN and ribavirin have an advance of fibrosis in a third , a stabilization of this in 60 % , while only 10 % shows progression of fibrosis despite the viral elimination .
A remarkable fact is that patients with more severe fibrosis have a forged response to antiviral discourse . It is potential that intrahepatic fibrogenic mechanisms can modulate the antiviral response . Similarly , the elimination of Hepatitis B Virus replication by means of antiviral treatment is connect with a statistical regression of the degree of liver fibrosis in almost half of the affected role . This effect has been described in various drug such as lamivudine , adefovir , entacavir , and tenofovir . It is nameless if any of these drugs could have an antifibrogenic action and , therefore , be suggest in patients with advanced fibrosis . There is little entropy about the effects of alcohol onanism on fibrosis in inebriant - stimulate liver disease . It is necessary to convey out young studies to evaluate the upshot of decreased alcoholic beverage intake or abstinence in these patients , as well as the broker that regularize the regression of fibrosis . There is late evidence bespeak that exercising weight passing after bariatric surgery is consociate with a histologic betterment of NASH ( non - alcohol-dependent steatohepatitis ) , with a diminution in fibrosis . This beneficial effect correlates with the standardisation of metabolic parameter and has been described even in patients with advance fibrosis .
ultimately , fibrosis secondary to biliary obstructer is reversed after surgically resolving the condition . All these clinical observation betoken that the evacuation of the causative factor leads to an improvement in liver fibrosis , disregardless of the movement .
The cellular and molecular mechanisms responsible for the reversibility of liver fibrosis in human being are unknown , as well as the environmental and genetic factors that shape the degradation of collagen . It is possible that after a prolonged follow - up , the fibrosis can be completely reversed in some patients . The knowledge of the mechanism involved in the regression toward the mean of fibrosis could help oneself to develop coadjuvant treatments for patient which respond to the etiological treatment , in decree to favour the abasement of the accumulated extracellular intercellular substance .
The existing field in patient do not allow recommending the use of any antifibrogenic drug at the moment . However , numerous data-based studies in rodents have demonstrated the utility of various drugs in models of chronicliver damage . Most of these drug , however , have not been inquire in controlled human studies .
Since fibrosis stand for a response to liver injury , the master treatment should focus on the case through the remotion of the element that injures the liver .
