n the early stages of liver fibrosis, symptoms are often absent (asymptomatic) or very mild, which is why early fibrosis may not be detected until the liver has sustained significant damage. However, as the condition progresses, individuals may experience:

• Fatigue: Persistent tiredness or low energy levels are associated with declining liver function.
• Discomfort or pain in the upper right abdomen: As the liver is located in the upper right abdomen, enlargement or swelling can cause discomfort.
• Itchy skin: This is caused as a result of bile salt accumulation.
• Loss of appetite and weight loss: These may occur as a result of impaired liver function.
• Nausea (urge to vomit) and vomiting: These are common symptoms associated with declining liver function.
• Jaundice and dark urine: These conditions may develop as a result of worsening liver function, i.e., inability to process bilirubin.

The diagnosis of early liver fibrosis often involves a combination of medical history, physical exams, and diagnostic tests.

• Medical history and physical examination: Information is collected about alcohol use, risk factors for liver disease (e.g., viral hepatitis, obesity, diabetes), and any symptoms. Physical examination may reveal signs of liver enlargement or tenderness.
• Blood tests:
  • Liver function tests: Elevated AST, ALT, ALP, and bilirubin levels can indicate liver injury.
• Imaging tests:
  • Elastography (FibroScan): This specialised ultrasound technique measures liver stiffness, which correlates with the degree of fibrosis.
  • Magnetic resonance elastography (MRE): This is an advanced form of elastography that assesses liver stiffness more accurately.
• Liver biopsy: In some cases, a liver biopsy may be necessary to definitively diagnose and grade the extent of liver fibrosis.

The treatment of early liver fibrosis focuses on addressing the underlying causes of liver fibrosis and preventing further liver damage. The earlier the diagnosis of fibrosis, the more likely it is to be reversible.

• Stop alcohol consumption: Abstinence from alcohol is critical for preventing further liver damage. Support programs, therapy, or medications may help individuals quit alcohol use.
• Manage underlying conditions:
  • Viral hepatitis: Antiviral treatment for hepatitis B and hepatitis C (e.g., direct-acting antivirals (DAAs)) can help reduce inflammation and fibrosis progression and prevent further liver damage.
  • Steatohepatitis (N/ASH): Managing obesity, type 2 diabetes, and insulin resistance through weight loss, exercise, and medications can help reduce liver fat and inflammation, i.e., steatohepatitis, which induces fibrosis.
• Medications: There are currently no approved drugs specifically for treating fibrosis, but anti-inflammatory drugs (such as steroids) may be used in specific cases of liver inflammation (like autoimmune hepatitis). Further, vitamin E has shown benefits in individuals with N/ASH, particularly in those who do not have diabetes.
• Weight loss: For individuals with obesity, N/AFLD, or N/ASH, gradual weight loss (5‒10% of the body weight) can significantly reduce liver fat and inflammation, thereby improving liver health and potentially reversing early fibrosis.
• Stringent control of diabetes and cholesterol: Tight control of blood glucose—in diabetes—and cholesterol levels can reduce the risk of fibrosis progression.
• Monitoring liver function: Regular monitoring of liver function through blood tests and imaging is essential to assess the progression of liver fibrosis and adjust treatment as needed.

The best strategy for preventing liver fibrosis involves avoiding heavy alcohol consumption; individuals at risk of developing liver fibrosis should stick to the recommended drinking limits or avoid alcohol entirely. Other strategies include: 

• Maintaining a healthy weight: Regular exercise and a balanced diet can help prevent obesity and reduce liver fat, which can prevent fibrosis.
• Managing metabolic risk factors: Controlling blood glucose levels, high blood pressure, and cholesterol levels can help prevent liver fibrosis.
• Vaccination: Individuals who are at risk of developing liver fibrosis should get themselves vaccinated against hepatitis B and C.
• Undergoing regular check-ups: Individuals with risk factors like viral hepatitis, obesity, or heavy alcohol use should undergo regular health check-ups to monitor their liver health.