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2016 ; 22
(24
): 5459-66
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Natural regression of fibrosis in chronic hepatitis B
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Ohkoshi S
; Hirono H
; Watanabe K
; Hasegawa K
; Kamimura K
; Yano M
World J Gastroenterol
2016[Jun]; 22
(24
): 5459-66
PMID27350724
show ga
The fibrosis of liver cirrhosis was considered to be irreversible before the
anti-viral drugs showed that it is reversible when they lead to continuous
suppression of viral replication and inflammation. However, several reports
previously showed that fibrosis of type B liver cirrhosis was almost completely
absorbed after the natural remission of chronic inflammation. This phenomenon
might not be limited to exceptional patients, but rather occur commonly,
considering the dynamic clinical features of chronic hepatitis B (CHB), where
inactive carrier stage normally follows aggravation of hepatitis and progression
of fibrosis at the time of HBeAg seroconversion. Thus, fibrosis levels of CHB as
a hepatocellular carcinoma (HCC)-surveillance marker, particularly those of the
inactive stage, could be underestimated, because some of them might have been
(pre)cirrhotic in the past and recovered with the natural regression of fibrosis.
We argue that cirrhosis-induced HCC mechanisms, rather than direct action of
viral genome, may be more common than generally considered in CHB patients. This
may have some impact on reconsidering the surveillance rationale for HCC in CHB,
from where advanced HCCs tended to be missed. In addition, a molecular marker to
assess the cancer-prone characteristics of the liver will definitely be needed to
resolve the issue.