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Cheng et al. Hepatoma Res 2017;3:156-69 Hepatoma Research
DOI: 10.20517/2394-5079.2017.27
www.hrjournal.net
Topic: Advances in the diagnosis and treatment of liver fibrosis Open Access

Advances in the diagnosis and treatment of

liver fibrosis

Jenny Yeuk-Ki Cheng , Grace Lai-Hung Wong 1,2,3
1,2
1 Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China.
2 Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, Shatin, Hong Kong 999077, China.
3 State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China.

Correspondence to: Dr. Grace Lai-Hung Wong, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street,
Shatin, Hong Kong 999077, China. E-mail: wonglaihung@cuhk.edu.hk
How to cite this article: Cheng JYK, Wong GLH. Advances in the diagnosis and treatment of liver fibrosis. Hepatoma Res 2017;3:156-69.

ABSTRACT
Article history: Liver fibrosis is the center of diagnosis and management of essentially all chronic liver diseases.
Received: 25-06-2017 While liver biopsy examination still has a role in diagnosis and drug development, it is replaced
Accepted: 26-07-2017 by non-invasive assessments of liver biopsy in majority of the clinical scenarios. Radiological
Published: 08-08-2017 approaches, namely transient elastography, acoustic radiation force impulse imaging, shear
wave elastography, magnetic resonance elastography provide accurate diagnosis of advanced
Key words: fibrosis and cirrhosis. Serum test formulae based on common laboratory parameters or more
®
®
Chronic hepatitis B, specialized parameters including those commercially available panels FibroTest , FibroMeter
chronic hepatitis C, and Enhanced Liver Fibrosis are also available. Combining different modalities may further
fatty liver, improve the accuracy. The role of all these non-invasive assessments has been further expanded
transient elastography from diagnostic to prognostic, e.g. risk prediction of hepatocellular carcinoma (HCC) by LSM-
HCC score. Treatment of liver fibrosis can be achieved by controlling the underlying diseases,
with chronic viral hepatitis as the most established disease model. Currently there are multiple
clinical trials evaluating different treatment options to improve fibrosis in patients with non-
alcoholic fatty liver disease. Specific anti-fibrotic treatment targets e.g. direct downregulation
of hepatic stellate cell, collagen synthesis inhibitors and transforming growth factor-β
antagonists have been tested in laboratory and pending further studies in clinical settings.

INTRODUCTION Apart from its relationship with HCC, liver fibrosis
is also an important treatment indication in various
Liver fibrosis is the formation of scar tissue in response chronic liver diseases. Different international treatment
to parenchymal injury secondary to chronic liver disease, guidelines mentioned that the severity of liver fibrosis
e.g. chronic hepatitis B and C, non-alcoholic fatty liver should be considered, regardless of the level of ALT,
disease (NAFLD) or alcoholism. It distorts the normal for starting antiviral treatment for chronic hepatitis
[1]
liver parenchyma. The continuous and progressive B (CHB). [3,4] There are solid evidence supporting
replacement of hepatocytes by extracellular matrix the fact that liver fibrosis is potentially reversible. [5]
and fibrous tissue leads to liver cirrhosis, which is a Therefore, it is important to diagnose and assess the
key risk factor for hepatocellular carcinoma (HCC). severity of liver fibrosis in order to provide appropriate
[2]
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