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Romanian Journal of Internal Medicine

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Liver Fibrosis: Causes and Methods of Assessment, A Review

Ali Erfani Karimzadeh Toosi
Published Online: 2015-12-10 | DOI: https://doi.org/10.1515/rjim-2015-0039


Hepatic fibrogenesis is the final result of injury to the liver. Fibrosis could lead to hepatic dysfunction, important in the pathogenesis of other chronic problems. Therefore, understanding the mechanism, accurate diagnosis and staging of it in early stages accelerates the treatment and reduces the prevalence of chirrosis. Treatment strategies of liver problems and detction methods depend on the amount and progression of liver fibrosis and the rate of cirrhosis development. Traditionally the invasive method, liver biopsy, is reference standard to follow progression and stage of fibrosis. However, during the past decade, progressive development of novel non-invasive methodologies has challenged the invasive method. Non-invasive methods have been initially introduced for chronic hepatitis C with increasing use in other chronic liver diseases. The need for liver biopsy has nowadays decreased significantly as a result of these methodologies. Most of the new non-invasive methods depend on either ‘biological’ or ‘physical’ approaches.

In this review, starting from the mechanism of fibrogenesis, the current knowledge about diagnosis, treatment strategies and different methods for its evaluation is discussed. This is followed by a conclusion on what is expected to be known in this field during the future research.

Fibrogeneza hepatică este rezultatul final al leziunii hepatice. Fibroza duce la disfuncţie hepatică ce determină alte comorbidităţi. Înţelegerea aşadar a mecanismelor fibrogenetice, realizarea unui diagnostic corect încă din stadiile timpurii duce la scăderea prevalenţei cirozei hepatice. Strategiile terapeutice şi metodele de detecţie depind de progresia fibrozei hepatice şi de rata dezvoltării cirozei. Tradiţional, standardul de aur pentru evaluarea cirozei hepatice este puncţia, biopsia hepatică, o manvera invazivă. În ultimul timp însă au fost dezvoltate mai multe metode non-invazive pentru a putea evalua mai uşor fibroza hepatică. Iniţial aceste metode au fost dezvoltate pentru pacienţii cu hepatită cronică cu virus hepatitic C. Astfel că necesitatea biopsiei a scăzut foarte mult în ultima vreme.

În acest articol tip review sunt trecute în revistă principalele mecanisme fibrogenetice, diagnosticul fibrozei hepatice, strategiile pentru evaluarea şi tratamentul fibrozei hepatice.

Keywords: Liver biopsy; FibroScan®; Fibrosis; Fibrosis mechanism; Fibrotest



Anion exchanger 2


Autoimmune pancreatitis


Alkaline phosphatase


Alanine aminotransferase;


Antimitochondrial antibodies




Aspartate-to-Platelet Ratio Index


Acoustic Radiation Force Impulse


Aspartate AminoTransferase


Aspartate aminotransferase/alanine aminotransferase ratio index


Area under the receiver operating characteristic curve


Body mass index


Controlled attenuation parameter


Cystic fibrosis transmembrane conductance regulator


Chronic hepatitis B


Chronic hepatitis C


Confidence interval


Chronic liver diseases


Cellular retinol-binding proteins


Colorectal cancer


Connective tissue growth factor




Extracellular matrix


Epithelial-mesenchymal transition


Endoscopic retrograde cholangio-pancreaticography


Epithelial-mesenchymal transition


Fibroblast growth factor-2


Fatty liver index




Genotype 1


Glial fibrillary acidic protein


Gamma-Glutamyl Transpeptidase


N-acetyl glucosaminyltransferase V


Hepatitis B virus


Hepatocellular carcinomas


Hepatitis C virus




Hepatocyte growth factor


Hepatic stellate cells


Insulin-like growth factor 1


Integrin-linked kinase


Interquartile range






King’s score


Liver biopsy


Lecithin-retinol acyltransferase


Liver Stiffness Measurement


Liver X receptor


Monocyte chemoattractant protein-1




Magnetic resonance cholangio-pancreaticography


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Nerve growth factor


Negative predictive value


Odds ratio


Perinuclear antineutrophil cytoplasmatic antibody


Primary biliary cirrhosis


E2 subunit of pyruvate dehydrogenase complex


Platelet-derived growth factor


Peroxisome proliferator activated receptor γ


Positive predictive value;


Primary sclerosing cholangitis


Prothrombin time


Ribonuclease inhibitor


Region of interest


Significant fibrosis


Supersonic shear imaging


Stellate cell activation-associated protein


Transient elastography


Transforming growth factor β


Ursodeoxycholic acid




Vibration-controlled transient elastography


Farnesoid X receptor (FXR), vitamin D receptor


Vascular endothelial growth factor


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About the article

Received: 2015-05-05

Published Online: 2015-12-10

Published in Print: 2015-12-01

Citation Information: Romanian Journal Of Internal Medicine, Volume 53, Issue 4, Pages 304–314, ISSN (Online) 1220-4749, DOI: https://doi.org/10.1515/rjim-2015-0039.

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© 2015 Ali Erfani Karimzadeh Toosi, published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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