Hepatic fibrosis: can we treat it clinically?

Hepatic fibrosis, a reparative response to different types of liver injury, has emerged as the primary determinant of outcome in advancing chronic liver disease, including cirrhosis. Once considered irreversible, today there is enough clinical as well as laboratory data available for us to be optimistic and expect regression of liver fibrosis in clinical situations, with resultant improvement in outcome. The primary premise of this approach to modify liver fibrosis has been its success in treating the basic pathology underlying persistent liver inflammation and injury, often with the reversal of cirrhosis. However, more focussed anti-fibrotics altering the dynamics of collagen deposition and resorption are undergoing evaluation and will be available shortly. In this changing scenario, there is a need for precise, easy to use endpoints of success/failure of anti-fibrotic therapy. A future scenario may be envisaged as one of a more positive, aggressive approach to treatment of chronic liver disease- treating the cause as well as using anti-fibrotics. This "hit the enemy and repair the hut" approach ushers in a new era from the hitherto barren pessimism in the treatment of chronic liver disease.