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Chronic Hepatitis

What Is It?

Hepatitis is an inflammation of the liver. In chronic hepatitis,
inflammation continues for six months or longer, with ongoing injury to
liver cells. This condition may be mild, causing little damage
(called chronic persistent hepatitis), or more serious, resulting in
liver-cell destruction and possible cirrhosis or liver failure (called
chronic active hepatitis).

Viruses are the most common cause of chronic hepatitis. Less common
causes include autoimmune disease, reactions to medications and
inherited metabolic disorders.

Viral causes include:

Hepatitis B and C: Two-thirds of all cases of chronic hepatitis result
from infection with hepatitis B and C viruses. Both of these viruses
usually begin with mild symptoms. Over time, perhaps a decade or more,
both may lead to serious complications, such as cirrhosis, liver failure
caused by irreversible damage and scarring, and, less commonly, liver
cancer. People infected with hepatitis C have the greatest risk of
developing chronic hepatitis. Chronic hepatitis C is nearly equal to
alcoholism as a risk factor for cirrhosis.

Hepatitis D: Hepatitis D by itself won't lead to chronic hepatitis.
However, in people also infected with hepatitis B, hepatitis D may
increase the risk of chronic hepatitis and worsen any complications.

Autoimmune chronic hepatitis: In this form of chronic hepatitis, the
immune system mistakenly destroys the body's own liver cells. What
triggers autoimmune chronic hepatitis is unknown. In most cases, it's a
progressive disease that leads to cirrhosis. It may appear with other
autoimmune diseases, such as systemic lupus erythematosus (lupus or SLE)
and antiphospholipid antibody syndrome (APS). Young women have the
highest rate of autoimmune chronic hepatitis, but it may affect women
and men of all ages.

Medications: Some medications also can lead to chronic hepatitis. These
medications include:

Isoniazid (Laniazid, Nydrazid) for tuberculosis Methyldopa (Aldomet,
Amodopa) for high blood pressure (hypertension) Phenytoin (Dilantin)
for seizure disorders

However, chronic hepatitis caused by medications is uncommon because
regular blood-test monitoring helps to ensure that liver problems are
noticed early. Discontinuing the medication usually reverses early liver
inflammation.

Some rare, inherited metabolic disorders also can lead to chronic
hepatitis. They include:

Wilson's diseases, a condition in which the body has difficulty
metabolizing copper Hemochromatosis, a condition of excessive iron
deposits in many of the body organs that can lead to chronic hepatitis
and cirrhosis Sarcoidosis, an inflammatory disease that can affect the
liver

Symptoms

At first, chronic hepatitis often does not cause any symptoms. People
with symptoms most commonly complain of fatigue. Fatigue worsens
throughout the day and may even be debilitating. Other common symptoms
include:

Mild upper abdomen discomfort Loss of appetite Nausea Aching joints

If chronic hepatitis becomes more severe, people may experience
additional symptoms, including:

Jaundice (yellowing of the skin and eyes) Abdominal swelling Weight loss
Muscle weakness Dark urine Coma

Diagnosis

Because chronic hepatitis often does not cause any early symptoms, the
disorder frequently is discovered during a routine blood test. If your
doctor suspects you may have chronic hepatitis, he or she may examine
you for jaundice, tenderness in the abdomen (especially the right upper
corner where the liver is located) and signs of ascites (fluid that
fills the abdomen during liver failure).

Blood tests may be performed to measure:

Liver enzymes, which are released when liver cells become inflamed or
damaged Bile-duct enzymes Levels of bilirubin, a pigment produced by
the breakdown of red blood cells — High levels of bilirubin cause
jaundice. Protein levels and clotting factors to assess how the liver
is functioning

If these tests show signs of liver inflammation or liver failure, you
will undergo tests for viral infection with Hepatitis B and C and for
antibodies that signal autoimmune hepatitis. Your doctor will review
medications you take now or have taken recently to determine if they
could be causing your chronic hepatitis. If the cause still is not
known, further blood tests will be ordered to check for uncommon causes.
An ultrasound or computed tomography (CT) test may be done to assess the
size of the liver. A small liver that appears scarred suggests
cirrhosis.

A liver biopsy may be recommended. In a biopsy, a small piece of tissue
from your liver will be examined under a microscope to help determine
the amount of scarring and the extent and type of liver damage. This
information helps to guide determine the best treatment and to assess
your chances of developing cirrhosis and liver failure. A liver biopsy
also can help to rule out other disorders, such as alcoholic liver
injury or fatty liver.

Expected Duration

By definition, chronic hepatitis is inflammation that continues for more
than six months. With mild or nonexistent symptoms, you may have chronic
hepatitis for some time before it is discovered. Treatment for some
types of viral chronic hepatitis can eliminate active infection.
However, the virus can remain dormant in cells, so the condition can
return.

Prevention

Usually, chronic hepatitis is caused by infection with the hepatitis B
or C viruses. These viruses primarily are passed from person to person
through ***ual contact or through contact with blood or other bodily
fluids when needles are shared or during blood transfusions. The reason
some cases of viral hepatitis become chronic hepatitis and others do not
remains unknown. The best prevention is to protect yourself against the
hepatitis B and C viruses.

Vaccinations for hepatitis B are recommended for health-care workers and
people traveling to certain countries. Infants are now routinely
vaccinated against hepatitis B. Condoms always should be used during
***ual contact to help prevent infection. Needles should never be
shared. When getting a tattoo or any body piercing done, make sure to
choose an establishment where all equipment is sterilized adequately.

Causes of and measures to prevent autoimmune chronic hepatitis remain
unknown.

If you are taking a medication that could affect your liver, make sure
to have your blood tested regularly to avoid the development of chronic
hepatitis or liver damage.

Treatment

The goal of treatment for chronic hepatitis is to prevent the disease
from getting worse, and to prevent cirrhosis and liver failure. In mild
cases of chronic hepatitis from hepatitis B or hepatitis C, treatment
may not be necessary and the condition may not get worse. With active
infection or if a liver biopsy shows early signs of damage, treatment is
more likely to be recommended to eliminate active infection. Treatment
isn't recommended for everyone because of the side effects and the
fairly high chance that active infection will return.

Therapy with a drug called interferon alpha is the most common treatment
for chronic hepatitis B and C. The drug is injected several times a week
for several months (usually five to six months, but sometimes a year).
Clinical trials are continuing to determine the best dosage and duration
of therapy to improve response and lower the chance that the condition
will return. Another medication approved for use alone in the treatment
of hepatitis B is the antiviral drug lamivudine
(Epivir). While it may work as well as interferon in some cases, it also
may lead to the development of viruses that are resistant to the
medication.

A combination of drugs may be used in some people. However, combination
therapy is not for everyone because it may cause more adverse reactions
than a single drug. Combination therapy has not been shown to work as
well in the treatment of hepatitis B, except in specific cases. Examples
of drugs used in combination therapy include lamivudine with interferon
for chronic hepatitis B, and ribavirin (Virazole) with interferon for
chronic hepatitis C.

Common side effects with interferon include:

Fatigue Muscle aches Headaches Nausea and vomiting Fevers Weight loss
Irritability and depression

If you have hepatitis C, you should receive the vaccine for hepatitis A
and B unless blood tests show that you are already immune to these
viruses. You can develop more serious infection from hepatitis A or B
than someone who does not have hepatitis C.

If you already have evidence of cirrhosis, you should have an endoscopy
to look for esophageal varices, enlarged veins in the esophagus that can
cause life-threatening bleeding. In an endoscopy, a flexible viewing
tube is inserted through your mouth into your esophagus.

Corticosteroid drugs are the main treatment of autoimmune chronic
hepatitis. These drugs suppress the immune system and may decrease
symptoms, improve liver condition and prolong survival. Your doctor may
prescribe prednisone alone or prednisone with azathioprine (Imuran),
another drug that works on the immune system.

Treatment for the less common forms of chronic hepatitis focuses on the
disease that is causing the condition. Medication-related chronic
hepatitis requires stopping or changing the drug.

If cirrhosis or liver failure develops, a liver transplant may be
needed.

If you have chronic hepatitis, you must avoid further liver damage from
alcohol or Tylenol. Discuss with your doctor how much Tylenol you can
take, if any. Remember that certain cold formulations and pain
medications also contain Tylenol.

Supportive care is key in coping with chronic hepatitis. A well-balanced
diet and good physical fitness can help you battle fatigue and improve
overall health. Limit salt intake to counteract the ac***ulation of
fluids and bodily swelling that may occur, especially if you develop
cirrhosis. Also, always talk to your physician before taking any
additional drugs, including prescription, nonprescription and
alternative medications. Your injured liver may not be able to detoxify
these

When To Call A Professional

If you experience persistent fatigue, the most common symptom of chronic
hepatitis, make an appointment to see your doctor. If you show signs
that could come from chronic hepatitis or liver failure, such as
jaundice, abdominal swelling or weight loss, you should call your doctor
for an evaluation.

Prognosis

Cirrhosis can lead to liver failure and death unless a liver transplant
can be performed. The likelihood of developing cirrhosis depends on the
severity of the disease as and the response to treatment. When a biopsy
shows more severe signs of damage, treatment can be important to help
decrease the risk of developing cirrhosis even if you do not have
symptoms. Other factors that affect the prognosis include age, other
medical illnesses, the subtype of virus and alcohol use.

Anyone with cirrhosis also has an increased risk of developing liver
cancer and must be screened regularly with a blood test and ultrasound
examination of the liver.

The risk of developing cirrhosis depends on the cause of the hepatitis
and the degree of inflammation. Symptoms and signs of cirrhosis may
develop in 15 percent to 30 percent of people who have had chronic
hepatitis infection for more than 20 years.

Here is the outlook for specific forms of chronic hepatitis:

Persistent chronic hepatitis, a milder type of hepatitis, may last
years, causing few problems, disappear with time, or may lead to
cirrhosis 10 or more years later. Chronic active hepatitis commonly
progresses to cirrhosis and liver failure, especially when left
untreated. Autoimmune chronic hepatitis is likely to progress to
cirrhosis. Treatment, however, can help control the symptoms and improve
survival.

Additional Info

American College of Gastroenterology (ACG)
4900 B South, 31st St.
Arlington, VA 22206
Phone: (703) 820-7400
Fax: (703) 931-4520
http://www.acg.gi.org/

American Autoimmune Related Diseases Association (AARDA)
22100 Gratiot Ave.
East Detroit, MI 48021
Phone: (810) 776-3900
http://www.aarda.org/

American Liver Foundation
75 Maiden Ln.
Suite 603
New York, NY 10038
Toll-Free: (800) 465-4837
http://www.liverfoundation.org/

National Institute of Diabetes and Digestive and Kidney Disorders
31 Center Dr.
Bethesda, MD 20892
Phone: (301) 496-3583
Fax: (301) 496-7422
http://www.niddk.nih.gov/

http://www.intelihealth.com/IH/ihtIH/EMIHC267/9339/31099/187089.html?d=dmtHealthAZ
Last updated March 26, 2003