Is fibrosis reversible?

Question

My first liver biopsy indicated that (Grade 3+) moderate inflammation and (Stage 3+) severe fibrosis based on Scheure Scoring System 0 - no fibrosis and 4 -cirrhosis. I was told my condition was bad and required immediate medical treatment. After 2 years of treatment, a 2nd biopsy was performed in a different hospital. The results were quite incredible: no (Stage 0) fibrosis but there was (Grade 2) mild inflammation. Is this possible for the end-stage of hepatitis?  I thought fibrosis is a permanent damage just like tooth cavity. Maybe the damage or fibrosis is different in the different parts of the liver. I am not feeling any better than before. I still suffer from brain fog  and still experience fatigue occasionlly. My doctor assured me that the pathologist who interpreted the specimen was top-notched in this field and disputed the result of the first biopsy. I do not want to spend  $12K for another biopsy.  Please comment!!

willing · Answer

if you're not going to rely on the experience of those who have gone before you, as summarized by outcome statistics, what else do you have to go on? In the absence of any real understanding of the mechanisms involved in fibrosis progression, virus persistence, drug effectiveness, etc., the record of individual treatment experiments (that would be us) is the only game in town. The only way to estimate one's personal probability of X, regardless of what X is, is by incorporating and weighing the available data. Obviously the outcome of a group that matches you more closely in race, age, genotype, point in treatment, etc. is going to carry more weight than a population-wide average, but if an across-the-board average is all that's available it still beats guessing. Biopsies are a good case in point. There's clear variability in the sample you draw : if you take two samples they can differ by 1 stage between in 30-45% of cases but rarely more than that (Siddique, et al 2003 and Regev, et al 2002) . Different pathologists also often come up with different scores from the same sample(Rousselet, et al 2005), and it looks like you're getter off getting a pathologist that's been doing it for a while. However, if you conclude that since biopsies are subject to error you should just trust your Dr's opinion, you're in even worse shape since it looks like they guess wrong about half the time Bain, et al 2004. CBee and Ina both recently posted questions about whether to continue tx. In Cbees's case there's a lot of data in Ina's there's none. Why would you not want to use all the information available to help make a decision?

LvdByGod! · Answer

hi lulu, thanks for the info.  i wonder how exactly that 30% sampling error is made? and i really wish i understood more about how the liver is composed cellularly...i just don't understand how it can be considered consistant when looking at cell pictures and especially pictures of a whole diseased liver...it looks lumpy in some areas and smooth in others. so strange. would the biopsy read the same if a lumpy area was biopsied rather than a smooth area for example? and how can that be? i wonder if you are saying that within each cell there is the bridging/scaring/fibrosis rather than on areas of the liver as a whole?...

i guess i need a biology lesson. oh well. thanks for the info...

sandi

Lulu2005 · Answer

The biopsy looks at the liver on a cellular basis. That is why a picture might not look like the liver has consistent damage throughout to the untrained eye, but it does.

It is rare for cirrhosis to be reversed but they are learning it is not impossible. However, remember there is a 30% sampling error on biopsies and that is huge.

TnHepGuy_ · Answer

another paper: Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C: A meta-analysis of individual patient data

LvdByGod! · Answer

ok guys here's my question. if a person was on treatment for 2 years and cleared, the liver would be able to regenerate especially in the areas that were not heavily scarred to begin with. so why would it be so hard to understand that at a second biopsy, when taking the sample, the dr could extract completely healthy tissue from an area of the liver that has completely regenerated?

doesn't it just come down to "where" in the liver he takes the  second sample from? i would imagin that some areas would have the scars that are there for life and other areas (the ones less damaged to begin with) would now have been regenerated.(?)

like a scar on the outside of the body some of it can disapear and other more deep or serious areas would be there forever.

is this the way it goes in the liver? why would we think that the liver stays completely uniform over the entire surface durring damage? the biopsy itself is such a tiny piece of the whole liver.  

when i look at liver pictures on janis' site there seems to be areas with lumps and bumps and areas that are less damaged. have you guys seen those pictures?  i'm just thinking it is possible  the second biopsy sample came from a completely regenerated area especially after there has been time for the healthier areas to completely regenerate or grow in. 

i can picture these areas eventually surrounding the scars but the scars remaining. i wonder if this is how it works? cirhosis and fibrosis are different right? cirhosis is hardening of the liver and you can't bring these back from the dead. but fibrotic areas could regenerate and surround them. 

then perhaps there is enough of the new regeneration to last the person a lifetime. unless they have other reasons that this new tissue could also be damaged, like fatty liver...(?) 

any thoughts??? 

if this is true the follow up biopsy could show us liver regeneration but can not answer the question as to whether there might be remaining scars on the liver somewhere unless the dr hits one of these areas with the biopsy needle.

what are you guys thoughts and research on this issue?

LvdByGod! · Answer

scott, then how do we explain those pictures of bad livers? do they look consistant to you? they don't to me...i would love to know your dr is right here. you are an intellegent man. you had the same questions...do you really believe this guy? 

by the way i hope you are doing well...thanks for responding to my question and i hope and pray your liver is doing well too. how are things with the question of the autoimmune problems? any word on that diagnosis?

i'm praying for you scott...

TnHepGuy_ · Answer

Fibrosis most certainly can be reversed via interferon and has shown to be so in many cases - most amazingly even in some patients with cirrhosis. Here are a few links with some information: Long-term benefit of interferon therapy of chronic hepatitis D: regression of advanced hepatic fibrosis Histologic Benefit of Peginterferon Alfa-2a (Pegasys) Monotherapy in Chronic HCV Patients with Advanced Fibrosis or Cirrhosis PEG-Intron Plus Ribavirin Improves Histology and Fibrosis in Nonresponders to Conventional Interferon and Ribavirin Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C: a meta-analysis of individual patient data Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C TnHepGuy

Tony-z · Answer

I agree with Scott. Interferon can reverse Fibrosis. Also clearing the Virus has been show to reverse much if not almost all of the fibrosis..

Below is a link to a web site explaining how this happen's and what fibrosis is..

<a href="http://janis7hepc.com/learning_about_liver_fibrosis2.htm#is%20liver%20fibrosis%20reversable">Click Here For the link</a>

http://janis7hepc.com/learning_about_liver_fibrosis2.htm#is%20liver%20fibrosis%20reversable

God Bless ..................TonyZ

whoaisme · Answer

A gentlemen in our hospital support group went from a stage 3 to either a 1 or 0, I don't remember exactly, but either way a BIG reversal!!! He was a 1 genotype and has been clear for over three years now. I guess it is possible!

snook_man · Answer

http://www.smj.org.uk/0204/fibrosis.htm

Here is an excellent link on fibrosis reversal. Moreover, cirrhosis reversal.

willing · Answer

Poynard et al 2002 stirred up a lot of controversy (see comments) with claims of clear link between ifn and reversal. I haven't kept up, but from a recent review Poynard 04it looks like he's sticking by his initial results. Am I understanding correctly that you did 2 years of tx or did you finish two years ago? Someone else on this board, BobK, reported getting a stage 0 reading on a post-tx bx and was equally incredulous (he was a stage 1 who did 2 years and relapsed but got a great bx result. I'm not sure about his initial stage, either 2 or 3 - anyone else remember?). With the right gauge needle, the margin of error on biopsy results is pretty small - enjoy the good news!

GreatBird · Answer

>>Right now my virus load is undetectable and liver function tests are normal(Alt 17 and Ast 18). Yet the hep symptoms still persist.<<

Those sure are some lovely numbers.

Maybe they aren't hep symptoms? I can't tell if you are male or female, but I've had lots of brain fog and fatigue from menopause. It can be due to other reasons as well.

snook_man · Answer

There has been many, many studies and articles about fibrosis reversal. One to two stages have been seen in many patients. Do a google search on "fibrosis reversal".. 
There is even greater reversal in those who obtain SVR. Study out of Italy claimed to have followed patients over 7 or 10 year period after tx. Two patients with cirrhosis, showed only minimal fibrosis. Even Dr Cecil states that the liver will repair itself, but only after obtaining SVR.. 
oF COURSE JUST LIKE TX AND THE DISEASE ITSELF, EVERY PERSON REACTS DIFFERENTLY!!

calagold · Answer

The doctor claimed the first biopsy specimen was to small (1.1 cm) to interprete correctly. So, he guessed it was probably a 2+ Staging Fibrosis. But from 2+ or 3+ to 0 is not quite possible? Right now my virus load is undetectable and liver function tests are normal(Alt 17 and Ast 18). Yet the hep symptoms still persist.

Mariacaro · Answer

It's awsome!!!
It is known that IFN reduce the fibrosis and inflammation...
It will be great if the Pathologists reviews both biopsy slides.

layla · Answer

The liver can get better but I have not hear that much either. You might check the size of the biopsies. They used to do them in much smaller pieces and found out that they need to be bigger and even perhaps have more than one. It sounds like great news for you. I did 18 months tx and now going on 1 year post tx I still have sides. They are getting to be less and less as time passes but it is fustrating. There is a person hear, doubledose who did a lot of tx and it took almost two years for his sx's to go away so you may feel better yet after more time. You did not say when you finished tx so maybe it's just to soon. LL

cuteus · Answer

if you have not done so, check the janis7hepc.com site, they are a great site for all questions Re hep c. fibrosis is reversible according to some studies. I would do a dogpile.com search on "fibrosis reversal" and read the abstracts.
your sample could be read by another pathologist if it is still available. I believe some drs think the fibrosure is comparable and less expensive to administer.

cougareyes · Answer

Hi I do hope you start feeling better, I just join the forum and this is the first time I've started to talk about it. My biopsy in Dec 04 revealed the same results as yours. My understanding is that you can get different results from different parts of the liver, the accuracy can also be determined by the size of the sample taken.This is another thing that makes this disease so frustrating.How do you feel now compaired to before you started tratment. Cougareyes

GreatBird · Answer

Interferon can reduce fibrosis in some patients. I have never heard it as dramatic as in your case, but others have posted a one or two  stages. 

Bear in mind that I'm not a doctor (nor is anyone else here) but I would think that different samples could lead to different results. Was the second doctor able to look at the first set of slides? Now that would be illuminating.

Is fibrosis reversible?

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