What is Liver Fibrosis and How is It Different from Cirrhosis?

Liver fibrosis is not an independent disease but rather a histological change caused by liver inflammation. Liver damage causes liver stellate cells to be over active and triggers the extra cellular matrix (ECM) synthesis to increase. More than normal amounts of collagen fiber deposits in the extra-cellular spaces of the liver cells and causes the liver cells to lose blood infusion and to be hardened.

Chronic viral hepatitis B and C are the most common causes of liver fibrosis. During the chronic hepatitis course, fibrosis is a part of the inflammation activities. In the fibrosis stage, there is no lobular regeneration and this distinguishes it from cirrhosis.  When fibrosis advances to cause fibrostic separations (or bridging) between the portal areas or between the portal area, the center vein, and the formation of pseudo-lobule, fibrosis enters the final stage, which is cirrhosis.

Histological (biopsy) diagnosis classifies the severity of fibrosis into five stages, S0 to S4.

S0 means no fibrosis. S4 is cirrhosis. In between, S1 is a mild fibrosis only seen at the portal area. S2 is a moderate stage of fibrosis, between portal areas, but without the destruction of the lobular structure. S3 is severe fibrosis.  At this stage, there is fibrostic bridging between portal areas and between portal areas and center veins. At S4, in addition to S3's changes, there are pseudo-lobules formed and this stage is the final stage, cirrhosis.

Liver fibrosis is the net result of the imbalance between the collagen fiber synthesis and decomposition. When fiber synthesis is very active and the decomposition is suppressed, fibrosis will progress. Vise versa, fibrosis can be reversed if the driver, inflammation, is controlled. When fibers form, at the early stage, it can be decomposed with water or weak acid. These are soluble fibers. Older fibers deposited for long time, becomes thicker and harder and cannot be decomposed by water or weak acids. Only collagen enzymes can decompose it.  With anti-fibrosis herbal treatment, there is possibility to suppress the HSC, enhance the activities of collagen enzymes and to promote the decomposition of the fibers, reducing ECM.    

Cirrhosis is always developed from fibrosis. Although, fibrosis and cirrhosis are different, they are closely related. They are two distinguished pathological conditions. At the fibrosis stages, the amount of collagen increases and the ratio of fibro-connective tissue verses liver cellular tissue increases. But at this stage, the liver lobular structures are intact. There is no pseudo-lobule formation. Cirrhosis consists of two pathological features: fibro-connective tissue hypertrophy and pseudo-lobule formation. At the cirrhosis stage, the liver's fundamental structure is deformed, and the framework of the liver begins collapse. Thus, reversal is more difficult at this stage.

Right now a liver biopsy is the most accurate way to diagnose the fibrostic stages. Some blood chemical measurements can also provide a referential diagnostic marker of fibrosis. The chemical markers that can be used to assess the fibrostic activities are: HA (hyaluronic acid), LN (Laminin), CIV(collagen IV), PCIII (procollagen type III) etc. They can show the activities of fibrosis, but can't classify stages of fibrosis.

Patients should also know that most chronic Hepatitis cases will not lead to Cirrhosis. Only a very small percentage does and it happens usually without proper treatment, allowing fibrosis to go on for years.

The body has amazing healing capabilities of its own and the liver is one of the most “re-generable” organs in the body. Because fibrosis is the result of the inflammation, halting or reversing fibrosis by controlling inflammation is the key. Special anti-fibrosis treatments have been developed in modern Chinese medicine and we will discuss these in next two weeks.