What is Hepatitis?
Hepatitis means inflammation of the liver. This inflammation may be due to
viruses, medicines, alcohol, problems with the immune system or not enough blood
supply to the liver.
The liver is an essential organ in the body and carries out a wide range of
functions, including removing poisons from the body, storing energy, and
regulation of blood clotting.
What is Viral Hepatitis?
Although other viruses can involve the liver, viral hepatitis refers to
inflammation of the liver due to one of several viruses that specifically attack
the liver. These viruses are labeled with the letters A, B, C, D and E. The most
important viruses in the United States are viral hepatitis A, B and C.
How is Viral Hepatitis transmitted?
Viral hepatitis A and E enter the body by way of the gastrointestinal tract. One
gets these viruses by eating food or drinking fluids contaminated with the
virus, usually from the stool of an infected person. Hepatitis A may also be
transmitted in areas where there is overcrowding such as day care centers and
correctional facilities, from eating raw shell fish that came from water
contaminated with sewage or by sexual (usually anal-oral) contact. Hepatitis E,
although similar to hepatitis A, is not frequently seen in the United States.
This virus is seen primarily in the Indian subcontinent and in certain areas of
Africa. It is transmitted primarily by fecal-oral contamination (as mentioned
above).
The hepatitis B and C viruses are generally transmitted by contact with infected
blood or blood products or by sexual contact. In the United States, intravenous
drug use is the most frequent mode of transmission of hepatitis C. Sexual
transmission is uncommon for hepatitis C. Hepatitis B is commonly transmitted
sexually as well as through intravenous drug use and can also be passed from a
mother to her fetus, usually at the time of delivery.
Hepatitis D (sometimes referred to as Delta hepatitis) only afflicts individuals
who have the hepatitis B infection. The mode of transmission of hepatitis D is
similar to that of hepatitis B.
What is Acute Viral Hepatitis and what are its symptoms and
consequences?
Acute viral hepatitis refers to inflammation of the liver associated with
symptoms and abnormalities of liver enzymes which last for a period less than
six months. All of the viruses mentioned above can cause acute hepatitis. The
symptoms of acute viral hepatitis can include low grade fever, headaches, muscle
ache, tiredness, loss of appetite, nausea, vomiting, diarrhea, dark colored
urine or light colored stools. The most notable symptom of acute viral hepatitis
is jaundice, which is a yellow discoloration of the skin and the whites of the
eyes. Patients also usually complain of vague upper abdominal pain. Very few
patients with acute viral hepatitis go on to develop liver failure that would
require liver transplantation or lead to death. However, hepatitis E may have
serious consequences if the person is infected during pregnancy.
Except for patients infected with hepatitis C, most cases of acute viral
hepatitis will disappear on their own. With hepatitis C, more than 80% of
patients will develop a persistent infection called chronic hepatitis. Although
most of those with acute hepatitis B will resolve their infection, a significant
number of infants and young children with hepatitis B will develop chronic
hepatitis B.
What is Chronic Hepatitis? What are its consequences?
Chronic viral hepatitis refers to ongoing inflammation and/or abnormalities of
liver enzymes which last more than six months. Most patients who develop chronic
hepatitis will have life long disease, unless treated. Chronic viral hepatitis
in the United States is limited primarily to hepatitis B and C. Consequences of
chronic viral hepatitis may include progressive liver disease, including
cirrhosis and its complications, liver failure, liver cancer, and bleeding
disorders, although many patients will never develop any of these complications.
Furthermore, chronic hepatitis may be accelerated in people who use drugs that
are toxic to the liver (including alcohol). Most of these complications can be
prevented by early diagnosis and early treatment, and in the case of hepatitis
B, vaccination.
How is Viral Hepatitis diagnosed?
Viral hepatitis (both acute and chronic) can be easily diagnosed using simple
blood tests. While a liver sample (called a biopsy) is not required in the vast
majority of cases, it may sometimes be helpful, especially in difficult to
diagnose cases or when deciding on treatment.
How is Viral Hepatitis treated?
Acute viral hepatitis generally does not require treatment, as most patients
will get better on their own. Acute hepatitis C is a notable exception, because
only 15% of patients will clear the virus on their own and most people, if not
treated, will develop chronic hepatitis C. In addition, there is a very high
cure rate when patients are treated during the acute hepatitis infection stage.
Chronic hepatitis treatments are available for hepatitis B and C, the most
predominant causes of chronic hepatitis. Chronic hepatitis B is usually treated
by medications that interfere with the virus' ability to reproduce. These
medications include oral medications as well as injectable medications. The only
approved injectable medications for chronic hepatitis B are alpha interferon and
pegylated alpha interferon. The duration of treatment for chronic hepatitis B is
dependent on many things, and can range from several months to life long.
Chronic hepatitis C is treated by a combination of injectable medication (alpha
interferon) and oral medication (ribavirin). The duration of treatment for
chronic hepatitis C ranges from six months to one year (depending upon the type
of virus, referred to as genotype). After treatment, the cure rate is about
40-50 percent but it is highly dependent on viral and host factors. Also,
monitoring of clinical symptoms and laboratory values during treatment of viral
hepatitis is very important.
Chronic viral hepatitis B and C should be treated by individuals who are
knowledgeable of these conditions, the medications utilized to treat these
conditions and the side effects of these medications.
Why is it important to treat Chronic Hepatitis? Are there side effects
associated with the medications used to treat Chronic Hepatitis B and C?
The main reason to treat chronic viral hepatitis is to prevent cirrhosis of the
liver, in which the liver becomes scarred and gradually loses its ability to
function. This can ultimately lead to liver failure or liver cancer. Another
reason for treatment is to prevent the spread of infection. The longer a patient
has chronic hepatitis, the more likely it is that cirrhosis will develop.
Therefore, early diagnosis is crucial for initiating treatment as soon as
possible. Unfortunately, since chronic viral hepatitis is usually not associated
with symptoms, most patients remain undiagnosed.
The medications used to treat chronic viral hepatitis C, including the
interferons and ribavirin, are associated with some side effects, most of which
are manageable. The most frequently seen side effects include tiredness, fatigue
and muscle aches, all resembling symptoms of the flu. Patients may also suffer
from low red blood counts (anemia) and a decrease in their white blood cell
count (these are the cells that are involved in fighting infections). Serious
side effects due to interferon may also occur quite rarely, including severe
depression and thoughts of suicide. Patients with stable depression generally
may be safely treated.
The oral medications that are used to treat chronic hepatitis B are typically
associated with minimal side affects. Hepatitis B may be treated with injectable
medications (pegylated interferons) or oral medications. All of these
medications, however, may require adjustments of doses and frequency in patients
who have kidney disease. As mentioned previously, patients with chronic viral
hepatitis should be treated in a center with a great deal of expertise in the
management of these side effects.
Can Viral Hepatitis be prevented?
Most cases of viral hepatitis can be prevented by using common sense
precautions. Since hepatitis A and E viruses are transmitted through
contaminated foods and liquids, patients should not eat or drink in areas with
unsanitary conditions. Hence, international travelers should only consume
bottled water, not use ice in beverages, and avoid food sold from street
vendors. Also, individuals traveling to areas with high rates of hepatitis A
should receive the hepatitis A vaccine in two (2) doses, 6 to 18 months apart.
Other persons who should receive the hepatitis A vaccine include men who have
sex with men, intravenous and other drug users, persons with clotting factor
disorders like hemophilia, people with chronic liver disease, and children who
live in areas that have historically high rates of hepatitis A. For short term
protection (for example, short term travel to endemic areas), immune globulin
(IG) shots may be given. This is generally needed for people who are going to
remain in those areas for a period of less than one month. This IG shot can
temporarily prevent you from contracting the virus. An IG shot may also be given
for protection within 2 weeks following exposure to a known hepatitis A carrier.
Most patients with acute hepatitis B will get better on their own, but this is a
preventable disease. The best method of prevention is vaccination. The hepatitis
B vaccine is highly effective in preventing the infection. Individuals who
should receive this vaccine include those who use intravenous and other drugs,
men who have sex with men, individuals with high risk sexual behavior and
individuals with multiple sexual partners. As pregnant women who carry the virus
are very likely to transmit it to their baby, newborns of hepatitis B infected
mothers should receive the first dose of the hepatitis B vaccine within 12 hours
of birth. It is also recommended that an IG (immune globulin) shot be given at
the same time. This method is highly effective in preventing infection of the
newborn. If the mother in addition has high amounts of the virus in her blood
stream, it is recommended that she receive an oral antiviral agent after the
second trimester of pregnancy to further reduce the risk of transmission to her
baby.
Most states currently require hepatitis B vaccination of all newborns as well as
"catch-up" vaccination for children and adolescents. A combined hepatitis A and
B vaccine (Twinrix) is also available for people who need both vaccines. These
vaccines offer life long immunity (as does recovery from infection) unless the
patient has underlying immune disease or kidney failure.
I heard that some medications such as herbal medications can cure Hepatitis. Is
this true?
Although some herbal medicines may briefly improve liver enzymes, there is
currently no evidence that any medicines (other than those previously mentioned)
can cure viral hepatitis. One should never use any prescription or
over-the-counter medications without consulting a physician first. Additionally,
some herbal medications may seriously damage the liver.
Author(s) and Publication Date(s)
George G. Abdelsayed, MD, FACP, FACG, and Daniel Stupak, MD, Bridgeport
Hospital, Bridgeport, CT - Published November 2010.
IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.