Hepatitis

Overview

Hepatitis is inflammation of the liver. Hepatitis is often caused by a virus; the most common being Hepatitis A, Hepatitis B, and Hepatitis C. Other causes may include heavy alcohol use, toxins, medication, or other medical conditions. 

This newsletter will focus on the most common viral causes of Hepatitis in the United States of America.

Hepatitis A (HAV)— A highly contagious viral condition that causes inflammation affecting the liver’s ability to function. It is most likely contracted from contaminated food, water or someone already infected. Mild cases don’t require treatment, and most who have the infection recover completely with no permanent liver damage.

Effective vaccines are available and recommended for children at age 1, anyone who didn’t get the vaccine at age 1, and for people traveling to areas with high rates of the illness. Practicing good hand hygiene is one of the best ways to protect against hepatitis A.

Hepatitis B (HBV) — For some people, hepatitis B infection becomes chronic, leading to liver failure, liver cancer or cirrhosis (a condition that causes permanent scarring of the liver). It is estimated that 20 to 30% of adults with chronic HBV will develop complications like cirrhosis and liver cancer. It is spread through bodily fluids (blood, semen). Most people infected as adults recover fully, even if their signs and symptoms are severe. Infants and children are much more likely to develop a chronic hepatitis B infection.

Screening for Hepatitis B infection is recommended:

• People born in regions with prevalence of HBV infection ≥ 2%
• US-born people not vaccinated as infants whose parents were born in regions with prevalence of HBV ≥ 8%
• Household and sexual contacts people with HBV infection
• Pregnant women
• Men who have sex with men
• Injection drug uses
• People with certain medical conditions
  • Immunosuppressive therapy 
  • Hemodialysis 
  • Infected with HCV or HIV

Although no cure exists for hepatitis B, treatment options are available.Treatment goal is to reduce the risk of liver damage and achieve a sustained suppression of HBV replication with normalization of liver enzyme blood tests. Also a vaccine is available which can prevent the disease. 

Vaccination is recommended for infants; children who weren’t vaccinated in infancy; people being treated for a sexually transmitted infection; health care workers and others who come in contact with blood on the job; people with end-stage kidney disease; and people traveling to areas with high rates of hepatitis B. If a person is already infected, taking certain precautions can help prevent the spread of hepatitis B to others.

Hepatitis C (HCV) — Most people infected with the hepatitis C virus have no symptoms. And most don’t know they have the hepatitis C infection until liver damage shows up decades later during routine medical tests. Generally considered to be among the most serious of the three viruses, hepatitis C is passed through contact with contaminated blood — most commonly through needles shared during illegal drug use and birth to an HCV-infected mother. More than half of people who become infected with HCV will develop chronic inflammation. 

Since this is an often asymptomatic disease, certain groups of people we know are at higher risk and should be screened for Hepatitis C infection. Here are the CDC recommendations: 

• Anyone who has injected drugs, even once, or many years ago
• Anyone who has received donated blood or organs before 1992
• Anyone born from 1945-1965
• Anyone with abnormal liver tests or liver disease
• Health and safety workers who have been exposed to blood on the job with a needlestick, sharps injury, or break in mucosa exposure
• Anyone on dialysis
• Anyone born to a mother with HCV

Hepatitis D (HDV) — Known as “delta Hepatitis” occurs only in HBV infected individuals as a coinfection (at the same time) or superinfection (following HBV infection). It is uncommon in the USA and may lead to chronic and severe disease. It is transmitted through bodily fluids similar to HBV. The diagnosis is made by detecting antibodies against HDV or HDV RNA. The diagnosis should be considered in any person with positive Hepatitis B surface Antigen who has severe symptoms or acute exacerbations. 

Hepatitis E (HEV) — Uncommon in the USA. The virus spread through the stool of infected individuals. You can get infected by drinking soiled water or after eating undercooked pork, venison or wild boar meat. Less often from raw shellfish. In most cases the infection resolves within 4 to 6 weeks without any sequelae.

Symptoms

These symptoms can last weeks to months following infection:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark Urine
• Grey-colored stools
• Jaundice (yellowing of the skin and eyes)
• Joint pain

Complications

Chronic inflammation of the liver can lead to:

• Cirrhosis
• Liver failure
• Liver transplant
• Liver cancer

Diagnosis

Blood testing is the only way to determine if you have viral hepatitis and/or have recovered from the disease. 

An ultrasound of the liver may shed light on the structure of the liver and the presence of any complications

The degree of inflammation, fibrosis or cirrhosis can be assessed by blood test, imaging and less commonly liver biopsy.

Treatment

Hepatitis A – usually no treatment is needed. With adequate rest, nutrition, fluids, and medical monitoring patients typically recover on their own after a few months. 

Hepatitis B – vaccination is the best way to prevent becoming infected with this disease. Adult patients often will fight off the virus and require no treatment, while others may develop a chronic form of the disease. Chronic Hepatitis B requires antiviral medication for treatment. 

Hepatitis C – no vaccination is available, avoiding high risk behaviors including IV drug use can lower your chances of infection. Chronic Hepatitis C has come a long way since the first treatment and currently almost all cases can be treated with an oral medication taking for a few weeks or months. Medications have become more tolerable and easier to take with fewer side effects. 

Hepatitis D – Interferon has been tried with minimal results. In severe cases liver transplant may be the only alternative. 

Hepatitis E – Supportive therapy with good hydration, rest, healthy foods and avoid alcohol. 

At Dakota GI, we look forward to working with you to provide the proper treatment and monitoring necessary to combat these conditions.