What is chronic hepatitis?
Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Many people have no symptoms, but some have vague symptoms, such as a general feeling of illness, poor appetite, and fatigue. Chronic hepatitis can result in cirrhosis, with an enlarged spleen, accumulation of fluid within the abdomen, and deterioration of brain function.
How common is chronic hepatitis?
Chronic hepatitis can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of chronic hepatitis?
In about two thirds of people, chronic hepatitis develops gradually, often without causing any symptoms of a liver disorder until cirrhosis occurs. In the remaining one third, it develops after a bout of acute viral hepatitis that persists or returns (often several weeks later).
Symptoms often include a vague feeling of illness (malaise), poor appetite, and fatigue. Sometimes affected people also have a low-grade fever and some upper abdominal discomfort. Jaundice is rare.
Often, the first specific symptoms are those of chronic liver disease or cirrhosis. They can include an enlarged spleen, small spiderlike blood vessels visible in the skin (called spider angiomas), redness of the palms, and accumulation of fluid within the abdomen. Liver malfunction may lead to deterioration of brain function, called hepatic (portosystemic) encephalopathy and a tendency to bleed (coagulopathy). Brain function deteriorates because toxic substances build up in the blood and reach the brain. The liver normally removes them from the blood, breaks them down, then excretes them as harmless by-products into the bile or blood. The damaged liver is less able to remove them.
A few people have jaundice, itchiness, and stools that are greasy and foul-smelling (called steatorrhea) and light-colored. These symptoms develop because the flow of bile out of the liver is blocked.
Autoimmune hepatitis may cause other symptoms that can involve virtually any body system, especially in young women. Such symptoms include acne, cessation of menstrual periods, joint pain, scarring of the lungs, inflammation of the thyroid gland and kidneys, and anemia.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes chronic hepatitis?
Chronic hepatitis is usually caused by one of the hepatitis viruses. Hepatitis C virus causes about 60 to 70% of cases, and at least 75% of acute hepatitis C cases become chronic. About 5 to 10% of hepatitis B cases, sometimes with hepatitis D co-infection, become chronic.
Hepatitis D does not occur by itself. It occurs only as a co-infection with hepatitis B. Rarely, hepatitis E virus causes chronic hepatitis in people with a weakened immune system, such as those who are taking drugs to suppress the immune system after an organ transplant, who are taking drugs to treat cancer, or who have HIV infection. Hepatitis A virus does not cause chronic hepatitis.
Certain drugs can cause chronic hepatitis, particularly when they are taken for a long time. They include isoniazid, methyldopa, and nitrofurantoin.
Other causes include alcoholic hepatitis and fatty liver disease not related to alcohol use (nonalcoholic steatohepatitis). Less often, chronic hepatitis results from alpha1-antitrypsin deficiency (a hereditary disorder), celiac disease, a thyroid disorder, or, in children and young adults, Wilson disease – a rare hereditary disorder involving abnormal retention of copper in the liver.
In many people with chronic hepatitis, no obvious cause can be identified. In some of these people, the chronic inflammation resembles inflammation caused by the body attacking its own tissues. This type of inflammation, called autoimmune hepatitis, is more common among women than men.
No one knows exactly why a particular virus or drug causes chronic hepatitis in some people but not in others or why the degree of severity varies.
What increases my risk for chronic hepatitis?
There are many risk factors for chronic hepatitis, such as:
- Have unprotected sex with multiple sex partners or with someone who’s infected with HBV
- Share needles during intravenous (IV) drug use
- Are a man who has sex with other men
- Live with someone who has a chronic HBV infection
- Are an infant born to an infected mother
- Have a job that exposes you to human blood
- Travel to regions with high infection rates of HBV, such as Africa, Central and Southeast Asia, and Eastern Europe
- Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
- Have ever injected or inhaled illicit drugs
- Have HIV
- Received a piercing or tattoo in an unclean environment using unsterile equipment
- Received a blood transfusion or organ transplant before 1992
- Received clotting factor concentrates before 1987
- Received hemodialysis treatments for a long period of time
- Were born to a woman with a hepatitis C infection
- Were ever in prison
- Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is chronic hepatitis diagnosed?
Doctors may suspect chronic hepatitis when people have typical symptoms, when blood tests (done for other reasons) detect abnormally high liver enzymes, or when people have had acute hepatitis before. Also, everyone born between 1945 and 1965, regardless of whether symptoms are present, should be tested once for hepatitis C. Such testing is recommended because hepatitis C is common among this age group and is often unrecognized.
Blood tests to determine how well the liver is functioning and whether it is damaged (liver function tests) are done. They may help establish or exclude the diagnosis, identify the cause, and determine the severity of liver damage. Blood tests are also done to help doctors identify which hepatitis virus is causing the infection. If no virus is identified, other blood tests are needed to check for other causes, such as autoimmune hepatitis. However, a liver biopsy is essential to confirm the diagnosis. The liver biopsy also enables a doctor to determine how severe the inflammation is and whether any scarring or cirrhosis has developed. The biopsy may help identify the cause of hepatitis.
If people have chronic hepatitis B, ultrasonography is done every 6 months to screen for liver cancer. Levels of alpha-fetoprotein – a protein normally produced by immature liver cells in fetuses – may increase when liver cancer is present and thus may also be checked to screen for liver cancer. People with chronic hepatitis C are screened similarly, but only if they have cirrhosis.
How is chronic hepatitis treated?
If a drug is the cause, the drug is stopped. If another disorder is the cause, it is treated.
Hepatitis A isn’t usually treated. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, you will be put on a special diet created by your doctor to prevent malnutrition or dehydration. Vaccination can also prevent hepatitis A infections by helping your body produce the antibodies that fight this type of infection. Most children receive the vaccination between ages 12 and 18 months. Vaccination is also available for adults.
Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be followed for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is progressing. The CDC recommends hepatitis B vaccinations for all newborns. The vaccine is also recommended for all healthcare and medical personnel.
Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment. People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.
Hepatitis D is treated with a medication called alpha interferon. According to the Public Health Agency of Canada, between 60 to 97 percent of people develop hepatitis D again even after treatment.
There are currently no specific medical therapies to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol.
Usually, corticosteroids (such as prednisone) are used, sometimes with azathioprine, a drug used to suppress the immune system. These drugs suppress the inflammation, relieve symptoms, and improve long-term survival. Nevertheless, scarring in the liver may gradually worsen. Stopping these drugs usually leads to recurrence of the inflammation, so most people have to take the drugs indefinitely.
Treatment of complications
Regardless of the cause or type of chronic hepatitis, complications require treatment.
If brain function deteriorates, drugs can be given to help the body eliminate the toxic substances that can cause the deterioration
Liver transplantation may be considered for people with severe liver failure. However, in people with hepatitis C, the virus virtually always recurs in the transplanted liver, and transplantation is less likely to be successful than transplantation done for other reasons.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage chronic hepatitis?
The following lifestyles and home remedies might help you cope with chronic hepatitis:
- Stop drinking alcohol. Alcohol speeds the progression of liver disease.
- Avoid medications that may cause liver damage. Review your medications with your doctor, including over-the-counter medications you take as well as herbal preparations and dietary supplements. Your doctor may recommend avoiding certain medications.
- Help prevent others from coming in contact with your blood. Cover any wounds you have and don’t share razors or toothbrushes. Don’t donate blood, body organs or semen, and advise health care workers that you have the virus. Also tell your partner about your infection before you have sex, and always use condoms during intercourse.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: February 26, 2017 | Last Modified: March 10, 2017
Chronic Hepatitis. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/chronic-hepatitis. Accessed 26 Feb, 2017.
Hepatitis C. http://www.mayoclinic.org/diseases-conditions/hepatitis-c/home/ovc-20207365. Accessed 26 Feb, 2017.