Chronic Hepatitis

What Is It?

Hepatitis is an inflammation of the liver. In chronic hepatitis, liver inflammation and injury to liver cells continues for at least six months. This condition may be mild, causing little damage (called chronic persistent hepatitis), or more serious, causing liver cells to be destroyed. Some cases lead to 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.

Viruses that cause hepatitis include:

• Hepatitis B and C These viruses cause two-thirds of all cases of chronic hepatitis. 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.
• 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 Sjögren's syndrome and autoimmune hemolytic anemia. Young women have the highest rate of autoimmune chronic hepatitis, but it can affect women and men of all ages.

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 tests help 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 disease, 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 fluid that fills the abdomen during liver failure.

Blood tests may be done 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 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 will be removed from your liver and 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 determine the best treatment and to assess your chances of developing cirrhosis and liver failure. A liver biopsy also can help to check for 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 virus. These viruses primarily are passed from person to person through sexual 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 way to protect against chronic hepatitis is to protect yourself against the hepatitis B and C virues. 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 sexual 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.

There is not way to prevent autoimmune chronic hepatitis because the cause is 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 goals of treatment for chronic hepatitis are 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 risk that active infection may return.

Viral hepatitis is treated with antiviral medications, such as interferon alpha (Roferon-A, Intron A), ribavirin (Copegus, Rebetol, Virazole) for hepatitis C and lamivudine (Epivir) for hepatitis B. Clinical trials are under way to determine the best combination of medications, dosage and length of treatment to improve response and lower the chance that the condition will return.

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 a test called 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.

Corticosteroids and other medications to suppress the immune system are the main treatment of autoimmune chronic hepatitis. These drugs may decrease symptoms, improve liver condition, and prolong survival.

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 your salt intake to counteract the accumulation 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

In its most severe stages, cirrhosis can lead to liver failure and death unless a liver transplant can be done. The likelihood of developing cirrhosis depends on the severity of the disease and the response to treatment. When a biopsy shows more severe 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% to 30% of people who have had chronic hepatitis infection for more than 20 years.

Additional Info

American College of Gastroenterology (ACG)

P.O. Box 3099

Arlington, VA 22302

http://www.acg.gi.org/

American Autoimmune Related Diseases Association (AARDA)

22100 Gratiot Ave.

East Detroit, MI 48021

Phone: (586) 776-3900

Toll-Free: (800) 598-4668

http://www.aarda.org/

American Liver Foundation

75 Maiden Lane

Suite 603

New York, NY 10038

Phone: (212) 668-1000

Toll-Free: (800) 465-4837

Fax: (212) 483-8179

E-Mail: info@liverfoundation.org

http://www.liverfoundation.org/

National Institute of Diabetes & Digestive & Kidney Disorders

Office of Communications and Public Liaison

Building 31, Room 9A04

31 Center Drive, MSC 2560

Bethesda, MD 20892-2560

Phone: (301) 496-4000

E-Mail: niddk_inquiries@nih.gov

http://www.niddk.nih.gov/