DEFINITION OF REVERSIBILITY OF LIVER FIBROSIS. DIANA ALCANTARA-PAYAWAL, MD Cardinal Santos Medical Center Fatima Medical University Center University of Santo Tomas. NATURAL HISTORY OF CHRONIC LIVER DISEASE. HEPATIC VENOUS PRESSURE GRADIENT (HVPG) mmHg.
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DEFINITION OF REVERSIBILITY OF LIVER FIBROSIS
DIANA ALCANTARA-PAYAWAL, MD
Cardinal Santos Medical Center
Fatima Medical University Center
University of Santo Tomas
NATURAL HISTORY OF CHRONIC LIVER DISEASE
HEPATIC VENOUS PRESSURE GRADIENT (HVPG) mmHg
Chronic liver injury leads to progressive fibrosis which ultimately develops to cirrhosis leading to portal hypertension , liver failure and hepatocellular carcinoma
Fibrosis is a dynamic bidirectional process which is potentially reversible.
CIRRHOSIS is progression of stages of increasing severity and non-reversibility
Stages accordingly to D Amico et al, J of Hepatology 2006
The Role of the Hepatic Stellate cell in FIBROGENESIS
ROLE OF EXTRACELLULAR MATRIX IN FIBROGENESIS
HEPATIC STELLATE CELL ACTIVATION-
CENTRAL EVENT IN LIVER FIBROSIS
Activated HSC with fibrosis
Friedman SL and Arthur, science and Medicine 2002
Reversal of cirrhosis is a complete restoration of normal architecture after the establishment of cirrhosis
Regression of fibrosis or cirrhosis, indicating that the fibrosis content is less than earlier, without quantifying the extent of regression or suggesting that the histology has returned completely to normal.
IREDALE , JCI, 2007
RESOLUTION OF FIBROSIS
Role of hepatic macrophages in matrix degradation through increased production of MMP-13
Clearance of stellate cells by apoptosis
Cross-linking of collagen by tissue transglutaminase is an importanctdeterminnt of fibrosis reversibility
1. Hepatic fibrosis as assessed by tissue pathology can regress especially after specific treatment (1a).
2. There is not enough evidence to suggest that cirrhosis
is reversible; however, remodeling can occur (3a).
3. Fibrosis regression is not synonymous with cirrhosis reversal (1a).
4. Liver architecture may not return to normal even after specific treatment (1a).
5. Hepatic function may not return to normal even after specific treatment (3a).
6. Vascular shunts when established do not reverse even after specific treatment (2a).