Regression of Steatohepatitis-Related Cirrhosis

Abstract

The authors document regression of cirrhosis in an obese 56-year-old man after significant weight loss by sequential liver biopsies. The patient had a known history of steatohepatitis. His initial laboratory workup 6 years earlier revealed elevated liver enzyme activities and blood triglyceride levels, and negative viral hepatitis serology screen. A liver biopsy at that time showed histological features consistent with precirrhotic stage of active steatohepatitis. A liver biopsy performed 4 years later revealed progression of the disease to cirrhosis. Following this diagnosis he went on a special strict diet and lost 49 kg. His body mass index decreased from 46 to 28 during a 2-year period and his liver enzyme activities returned to normal. A liver biopsy at this time demonstrated significant regression of the liver fibrosis and disappearance of the steatosis and necroinflammation. In conclusion, massive weight loss resulted in resolution of liver fibrosis in this obese patient with steatohepatitis-related cirrhosis.

Keywords

cirrhosis - fibrosis - regression - steatohepatitis - liver - weight loss

• References

• 1 Germani G, Hytiroglou P, Fotiadu A, Burroughs AK, Dhillon AP. Assessment of fibrosis and cirrhosis in liver biopsies: an update. Semin Liver Dis 2011; 31 (1) 82-90
• 2 Abdel-Aziz G, Lebeau G, Rescan PY , et al. Reversibility of hepatic fibrosis in experimentally induced cholestasis in rat. Am J Pathol 1990; 137 (6) 1333-1342
• 3 Iredale JP, Benyon RC, Pickering J , et al. Mechanisms of spontaneous resolution of rat liver fibrosis. Hepatic stellate cell apoptosis and reduced hepatic expression of metalloproteinase inhibitors. J Clin Invest 1998; 102 (3) 538-549
• 4 Falize L, Guillygomarc'h A, Perrin M , et al. Reversibility of hepatic fibrosis in treated genetic hemochromatosis: a study of 36 cases. Hepatology 2006; 44 (2) 472-477
• 5 Wanless IR. Is cirrhosis reversible?. J Gastroenterol Hepatol 2004; 19: s344-s345
• 6 Bortolotti F, Guido M, Cadrobbi P , et al. Spontaneous regression of hepatitis B virus-associated cirrhosis developed in childhood. Dig Liver Dis 2005; 37 (12) 964-967
• 7 Friedman SL, Bansal MB. Reversal of hepatic fibrosis — fact or fantasy?. Hepatology 2006; 43 (2) (Suppl. 01) S82-S88
• 8 Kweon YO, Goodman ZD, Dienstag JL , et al. Decreasing fibrogenesis: an immunohistochemical study of paired liver biopsies following lamivudine therapy for chronic hepatitis B. J Hepatol 2001; 35 (6) 749-755
• 9 Czaja AJ, Carpenter HA. Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis. J Hepatol 2004; 40 (4) 646-652
• 10 Kaplan MM, DeLellis RA, Wolfe HJ. Sustained biochemical and histologic remission of primary biliary cirrhosis in response to medical treatment. Ann Intern Med 1997; 126 (9) 682-688
• 11 Serpaggi J, Carnot F, Nalpas B , et al. Direct and indirect evidence for the reversibility of cirrhosis. Hum Pathol 2006; 37 (12) 1519-1526
• 12 Dufour JF, DeLellis R, Kaplan MM. Regression of hepatic fibrosis in hepatitis C with long-term interferon treatment. Dig Dis Sci 1998; 43 (12) 2573-2576
• 13 Chang CY, Martin P, Fotiadu A, Hytiroglou P. A patient with chronic hepatitis B and regression of fibrosis during treatment. Semin Liver Dis 2010; 30 (3) 296-301
• 14 Kleiner DE, Berk PD, Hsu JY , et al; LABS Consortium. Hepatic pathology among patients without known liver disease undergoing bariatric surgery: observations and a perspective from the longitudinal assessment of bariatric surgery (LABS) study. Semin Liver Dis 2014; 34 (1) 98-107
• 15 Dixon JB, Bhathal PS, Hughes NR, O'Brien PE. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatology 2004; 39 (6) 1647-1654
• 16 Lee UE, Friedman SL. Mechanisms of hepatic fibrogenesis. Best Pract Res Clin Gastroenterol 2011; 25 (2) 195-206
• 17 Friedman SL. Mechanisms of hepatic fibrogenesis. Gastroenterology 2008; 134 (6) 1655-1669
• 18 Harrison SA, Torgerson S, Hayashi P, Ward J, Schenker S. Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis. Am J Gastroenterol 2003; 98 (11) 2485-2490
• 19 Wanless IR, Nakashima E, Sherman M. Regression of human cirrhosis. Morphologic features and the genesis of incomplete septal cirrhosis. Arch Pathol Lab Med 2000; 124 (11) 1599-1607
• 20 Kleiner DE, Brunt EM, Van Natta M , et al; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41 (6) 1313-1321
• 21 Fischer S, Guindi M. Regressed cirrhosis case. In: Ferrell LD, Kakar S, , eds. Liver Pathology. New York, NY: Demos Medical; 2011: 199-201
• 22 Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003; 38 (6) 1449-1457