Hepatitis


Hepatitis in lay man’s term means inflammation within the liver. It can occur due to multiple causes and includes viral infections like hepatitis A, B, C and E; excessive intake of alcohol ( Alcoholic hepatitis ) or due to some triggers within the body which causes the liver to be attacked by the body’s own defense mechanism ( autoimmune hepatitis ) etc.

The most common cause of Hepatitis in India is Hepatitis A and Hepatitis E, which usually spreads through contaminated drinking water and food and mostly by the feco-oral route where there is contamination of food with fecal matter due to improper hygiene. Most of the cases of hepatitis A and E are self-limiting. It has a crescendo-decrescendo course wherein initially, there will be a rise in liver enzymes (SGOT and SGPT) followed by the development of jaundice. The entire episode may be preceded by a viral prodrome which could include fever, malaise, loss of appetite, nausea etc. The course of this hepatitis is usually around 6 to 8 weeks. However, some cases of hepatitis A can last as long as 6 months. Though some rare cases of chronic hepatitis E have been reported, yet for all practical purposes hepatitis A and E disappear from the body mostly within 6 months. There are no specific medicines which can cure this condition or fasten the recovery. Medicines are given only to support the liver during this period of crisis. The drugs take care of the nutrition, vomiting and other associated symptoms. There is no role of any alternative or complementary medicines and may, in fact, be harmful. As per current scientific evidence, there is also no specific dietary restriction for hepatitis and patient can take any food he wants except those to which he himself feel bloated and nauseated. Rest is very important in this condition as some patients may have a double peak or a relapse of the disease. Effective vaccines are available against Hepatitis A but not against Hepatitis E. Clean drinking water and safe eating habits are most important in prevention as the disease does not confer any lifelong immunity and patients can have the disease again if he gets contaminated.

Hepatitis B may be acute (acquired within last 6 months ) or chronic ( more than 6 months). Most of the acute hepatitis B is again self-limiting within 6 months in adults, but around 5% of this acute adult hepatitis B can proceed into the chronic state.  On the other hand, more than 95% of infants and children who acquire hepatitis b, usually proceed to a chronic state. Not all patients with chronic Hepatitis b needs treatment.  HBsAg positive merely indicates that the virus is there inside the liver cells. It may be lying in the liver cells without causing harm or may be causing damage to the liver. We can know what the virus is doing by doing some blood tests and an ultrasound.  The liver enzymes SGPT elevation is a sign that the virus may be causing harm. But we need to know that the liver enzymes may be raised due to other conditions also like alcohol and fatty liver.   So, there should not be panic if there is hepatitis b positive. The patient might just be a carrier of the virus. If the majority of these patients are followed up in the long run, only a small 5-10% will need medicines. However, all patients should be on regular follow up as there are no signs by which we can know if the virus is causing harm. By the time the signs come, it may be late. So a regular liver function test monitoring every 3-6 months is needed for all these patients.  If medicines are required, there are excellent medicines to keep the virus under control.  Hepatitis b, unlike A and E, can cause liver cirrhosis and liver cancer and therefore regular consultation is very important.

  • Family member should be screened and If found negative, they should be vaccinated
  • All patients with hepatitis b positive should
    • Avoid unprotected sexual contact till partner is vaccinated. Use Condoms till partner is vaccinated.
    • Avoid contact with blood products of infected
    • Avoid sharing of toothbrushes and razors
  • If unmarried, then the  partner is advised to be vaccinated before marriage
  • Hep B positive females can become pregnant, but they have a risk of transmitting the virus to off-springs. Adequate precautions have to be taken during pregnancy and the newborn has to receive Ig injection at the time of birth to lower this risk

HEPATITIS C once detected by getting a report of Anti HCV positive should always be confirmed by doing a confirmatory HCV RNA test. If the HCV RNA is positive, then the patient will need treatment based on the genotype of the virus. All patients with HCV RNA positive unlike hepatitis b should be treated. Since 2015, when oral direct-acting antiviral drugs came into the market, the success rate of treatment is above 90%. However, it is important that the patient is treated before cirrhosis of the liver (which is irreversible) sets in. Else, we can make the patient negative of the virus but the liver cirrhosis will continue and would need treatment.

AUTOIMMUNE HEPATITIS is a relatively rare form of liver inflammation, wherein the antibodies within our own body consider the liver cells as foreign and start attacking them. This, in turn, causes a rise of liver enzymes and development of jaundice. This is more common in females and may need a liver biopsy to reach a final conclusion. The treatment is rewarding and is usually with steroids and long-term immunosuppression.