Early liver fibrosis Home A-Z Health Information Health Library A-Z Early Liver Fibrosis Overview Liver fibrosis refers to the excessive accumulation of a fibrous mesh (scar tissue) in the liver as a response to chronic injury or inflammation. Early liver fibrosis refers to the initial stage of this condition and may not produce noticeable symptoms. However, if untreated, it can progress to advanced fibrosis, which can further progress to severe forms, such as cirrhosis, which can result in liver failure. Causes and risk factors The primary cause of liver fibrosis is ongoing liver injury. Some common causes include:Chronic alcohol consumption: Heavy, long-term alcohol abuse is one of the major causes of liver fibrosis. Alcohol consumption leads to liver damage and inflammation, which triggers the formation of scar tissue.Chronic viral hepatitis: Persistent inflammation from Hepatitis B and Hepatitis C promotes fibrosis.Fatty liver disease: Both alcoholic and non-alcoholic fatty liver disease (AFLD and NAFLD) can progress to steatohepatitis (alcoholic and non-alcoholic; ASH and NASH), which leads to fibrosis.Steatohepatitis: Both alcoholic and non-alcoholic steatohepatitis (ASH and NASH) induce liver inflammation, which promotes fibrosis.Chronic liver disease (other causes): Conditions such as autoimmune hepatitis (the body's immune system mistakenly attacks its own liver cells), Wilson’s disease (copper buildup in the liver), and hemochromatosis (iron accumulation) can lead to liver fibrosis.Medications and toxins: Certain medications—methotrexate, isoniazid, amiodarone—and long-term exposure to toxic substances can damage the liver and promote fibrosis.Obesity and insulin resistance: Being overweight or obese, especially with insulin resistance (a precursor to diabetes), increases the risk of developing liver fibrosis.Genetic conditions: Genetic disorders such as alpha-1 antitrypsin deficiency or cystic fibrosis can also cause chronic liver injury, resulting in fibrosis.Cholestatic liver diseases: Conditions that obstruct bile flow, like primary biliary cholangitis or primary sclerosing cholangitis, can lead to fibrosis.Several factors increase the likelihood of developing early liver fibrosis; these include:Chronic alcohol use: Excessive drinking over many years increases the risk of fibrosis, especially in genetically predisposed individuals.Obesity and overweight: Being overweight or obese is a major risk factor, especially in the context of metabolic disorders like type 2 diabetes or insulin resistance.Viral hepatitis: Chronic hepatitis B or hepatitis C infections are a major risk factor for developing fibrosis and cirrhosis.Metabolic syndrome: A combination of high blood pressure, high cholesterol levels, elevated blood sugar levels, and abdominal obesity increases the likelihood of developing fibrosis.Diabetes: Diabetes, especially when poorly controlled, increases the risk of liver fibrosis due to associated fatty liver.Age: As people age, the liver’s ability to regenerate decreases, which can lead to a higher risk of fibrosis in individuals with ongoing liver injury.Gender: Men are generally at a higher risk of developing liver fibrosis due to alcohol use, but women are more susceptible to fibrosis associated with NAFLD/NASH.Genetics: Individuals with specific genetic mutations, such as those associated with hemochromatosis (iron overload), Wilson’s disease, or alpha-1 antitrypsin deficiency, are at higher risk of liver fibrosis. Symptoms n the early stages of liver fibrosis, symptoms are often absent (asymptomatic) or very mild, which is why early fibrosis may not be detected until the liver has sustained significant damage. However, as the condition progresses, individuals may experience:Fatigue: Persistent tiredness or low energy levels are associated with declining liver function.Discomfort or pain in the upper right abdomen: As the liver is located in the upper right abdomen, enlargement or swelling can cause discomfort.Itchy skin: This is caused as a result of bile salt accumulation.Loss of appetite and weight loss: These may occur as a result of impaired liver function.Nausea (urge to vomit) and vomiting: These are common symptoms associated with declining liver function.Jaundice and dark urine: These conditions may develop as a result of worsening liver function, i.e., inability to process bilirubin. Diagnosis The diagnosis of early liver fibrosis often involves a combination of medical history, physical exams, and diagnostic tests.Medical history and physical examination: Information is collected about alcohol use, risk factors for liver disease (e.g., viral hepatitis, obesity, diabetes), and any symptoms. Physical examination may reveal signs of liver enlargement or tenderness.Blood tests:Liver function tests: Elevated AST, ALT, ALP, and bilirubin levels can indicate liver injury.Imaging tests:Elastography (FibroScan): This specialised ultrasound technique measures liver stiffness, which correlates with the degree of fibrosis.Magnetic resonance elastography (MRE): This is an advanced form of elastography that assesses liver stiffness more accurately.Liver biopsy: In some cases, a liver biopsy may be necessary to definitively diagnose and grade the extent of liver fibrosis. Treatment The treatment of early liver fibrosis focuses on addressing the underlying causes of liver fibrosis and preventing further liver damage. The earlier the diagnosis of fibrosis, the more likely it is to be reversible.Stop alcohol consumption: Abstinence from alcohol is critical for preventing further liver damage. Support programs, therapy, or medications may help individuals quit alcohol use.Manage underlying conditions:Viral hepatitis: Antiviral treatment for hepatitis B and hepatitis C (e.g., direct-acting antivirals (DAAs)) can help reduce inflammation and fibrosis progression and prevent further liver damage.Steatohepatitis (N/ASH): Managing obesity, type 2 diabetes, and insulin resistance through weight loss, exercise, and medications can help reduce liver fat and inflammation, i.e., steatohepatitis, which induces fibrosis.Medications: There are currently no approved drugs specifically for treating fibrosis, but anti-inflammatory drugs (such as steroids) may be used in specific cases of liver inflammation (like autoimmune hepatitis). Further, vitamin E has shown benefits in individuals with N/ASH, particularly in those who do not have diabetes.Weight loss: For individuals with obesity, N/AFLD, or N/ASH, gradual weight loss (5‒10% of the body weight) can significantly reduce liver fat and inflammation, thereby improving liver health and potentially reversing early fibrosis.Stringent control of diabetes and cholesterol: Tight control of blood glucose—in diabetes—and cholesterol levels can reduce the risk of fibrosis progression.Monitoring liver function: Regular monitoring of liver function through blood tests and imaging is essential to assess the progression of liver fibrosis and adjust treatment as needed. Prevention The best strategy for preventing liver fibrosis involves avoiding heavy alcohol consumption; individuals at risk of developing liver fibrosis should stick to the recommended drinking limits or avoid alcohol entirely. Other strategies include: Maintaining a healthy weight: Regular exercise and a balanced diet can help prevent obesity and reduce liver fat, which can prevent fibrosis.Managing metabolic risk factors: Controlling blood glucose levels, high blood pressure, and cholesterol levels can help prevent liver fibrosis.Vaccination: Individuals who are at risk of developing liver fibrosis should get themselves vaccinated against hepatitis B and C.Undergoing regular check-ups: Individuals with risk factors like viral hepatitis, obesity, or heavy alcohol use should undergo regular health check-ups to monitor their liver health.