Liver Fibrosis: Management, Medications, & Treatment Options

Liver fibrosis is the buildup of scar tissue caused by liver disease or viral infections. Over time, healthy tissue in the liver is replaced with stiff scar tissue that can change the size and shape of your liver. If left untreated, severe liver fibrosis eventually leads to permanent liver damage or cirrhosis (late-stage liver disease).1

You may be wondering, can liver disease be cured? Fortunately, liver disease and fibrosis can be treated and reversed if they’re diagnosed before any lasting damage is done.2 Many treatments focus on treating the causes of liver disease or infections to reduce inflammation and scar tissue formation.

Your doctor can prescribe you certain medications to help treat the underlying cause of your liver fibrosis. If your fibrosis has progressed to cirrhosis, you may need a liver transplant. Your doctor can also prescribe medications to treat complications from cirrhosis, such as high blood pressure and swelling.3

Treatments for Liver Fibrosis

The overall goal of liver fibrosis treatment is to address the underlying cause and prevent more scar tissue formation and damage. Your doctor may suggest one or more treatments to help manage liver disease, infections, and other causes of liver fibrosis.

Alcohol-Associated Liver Disease

If you have alcohol-associated liver disease, your doctor will recommend completely avoiding alcohol. This helps reduce inflammation and further damage to your liver. If you’re having trouble limiting your alcohol consumption, they may recommend that you attend a treatment program or a support group.3

Chronic Hepatitis B Infections

Chronic (long-term) infection with the hepatitis B virus (HBV) is associated with liver damage and scar tissue formation. A vaccine for hepatitis B is very effective. However, hepatitis B cannot be cured, and some patients require treatment. If you have chronic HBV, your doctor may prescribe you an antiviral medication to block the virus. The medications that are most effective include tenofovir, tenofovir alefenamide, and entecavir.

Side effects of antiviral medications include headache, indigestion and gas, flu-like symptoms, and rashes.

Chronic Hepatitis C Infections

Chronic infection with the hepatitis C virus (HCV) is a common cause of liver fibrosis. Fortunately, hepatitis C can be cured. Direct-acting antiviral (DAA) medications are available to prevent the virus from replicating in your body. Examples of DAAs include:9-13

  • Glecaprevir and pibrentasvir (Mavyret®)
  • Sofosbuvir (Sovaldi®)
  • Sofosbuvir and velpatasvir (Epclusa®)
  • Ledipasvir and sofosbuvir (Harvoni®)

Side effects you may experience include nausea, headache, muscle pain, and difficulty sleeping.

Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) causes an accumulation of fat in the liver that can eventually lead to fibrosis. Many people with this disease are overweight or obese and have high blood sugar and cholesterol levels. If you have NAFLD, your doctor will likely recommend lifestyle changes that can help you reach a healthier weight.

Eating a healthy, plant-based diet that’s low in sugar and fats can help bring your blood sugar and cholesterol levels within normal ranges. Adding at least 30 minutes of exercise per day most days of the week can help your cells become more sensitive to insulin, lowering your blood sugar.14

Diseases That Damage Bile Ducts

Some diseases — such as primary sclerosing cholangitis or primary biliary cholangitis — can damage or block the bile ducts. These ducts carry bile from the gallbladder and liver through the pancreas to the small intestine. When bile ducts are blocked, bile accumulates in the liver, leading to liver damage and fibrosis.3

Your doctor may recommend ursodiol, a medication used to treat gallstones. Obeticholic acid is a medicine used if ursodiol hasn’t helped enough, or in patients who can’t take ursodiol. In more severe cases, a procedure to open a blocked infected duct or a liver transplant is needed.15

Treatments for Cirrhosis and Associated Complications

Once liver fibrosis progresses to cirrhosis, it can’t be reversed. Your doctor will recommend treatments to help manage complications of cirrhosis and reduce your risk of liver failure (when your liver stops working completely).

Cirrhosis may cause high blood pressure in the portal vein (portal hypertension), which carries blood from your gastrointestinal tract into your liver. Cirrhosis symptoms are typically caused by portal hypertension — fortunately, these can be managed with medications and lifestyle changes, including:3

  • Blood pressure medications: These medications help lower blood pressure in several veins around your body to reduce the risk of internal bleeding
  • Diuretics: Also known as “water pills,” these medications help your body get rid of excess water and salt to treat fluid buildup, swelling, and high blood pressure
  • Limiting salt: Salt causes your body to hold onto water — by limiting salt in your diet, your body can clear out fluid more easily

Liver Transplant

Severe cases of cirrhosis can eventually lead to liver failure. The only treatment for liver failure is a liver transplant. The liver has the ability to regenerate and grow to its normal size from only a portion of tissue. Some people may receive a living-donor transplant rather than waiting for a deceased donor. According to the Mayo Clinic, the number of people who need a liver transplant greatly outweighs the number of available donors.16

A liver transplant is a last-resort treatment option that’s often associated with significant complications. Your body may reject the new liver, or you may develop health complications from taking anti-rejection medications. Your doctor will go over the benefits and risks of a liver transplant with you before you’re placed on the waitlist.

The Future of Liver Fibrosis Treatments

Doctors and researchers continue to look for new ways to treat liver fibrosis and cirrhosis. Many of these are currently in clinical trials to ensure they’re safe and effective. Examples include vaccines for HBV and medications to treat complications from cirrhosis.