Chronic Hepatitis

Chronic hepatitis is inflammation of the liver persisting for more than six months which can range from being mild to being severe that may lead to liver failure. ^[1]

Causes

Chronic hepatitis is very much associated with hepatitis virus. Hepatitis virus is classified into several types. Hepatitis A and E viruses are two types that do not cause chronic hepatitis. 60-70% of cases are caused by Hepatitis C virus and a majority of people diagnosed with acute hepatitis C progress to the chronic type.  A small percentage (5-7%) of hepatitis B cases becomes chronic especially those with concomitant hepatitis D infection. ^[2] Viruses like cytomegalovirus and Epstein-Barr virus are also suggested etiologies of the disease.  Other common causes of chronic hepatitis include alcohol, Non-Alcoholic Steatohepatitis (NASH) and autoimmune hepatitis. Some drugs may also cause chronic hepatitis. Among these are isoniazid, methyldopa, amiodarone, phenytoin and macrodantin. Some metabolic disorders that are being linked to chronic hepatitis include Wilson’s disease, hemochromatosis and sarcoidosis. Likewise, autoimmune diseases such as primary biliary cirrhosis and primary sclerosing cholangitis are also associated to the said disease. ^[1]

Signs and Symptoms

Chronic hepatitis has a wide array of symptoms. Among these are fatigue, weight loss, muscle pain, swelling of the ankle, skin itchiness, dark urine, easy bruisability and breast swelling. The patient can also feel pain at the right upper area of the abdomen and the abdomen can be distended. There can be vomiting of blood and the stools can be black and tarry. Jaundice or yellowing of the skin and the white areas of the eye is another sign. Some patients may have an excessive growth of facial or body hair termed hirsutism or tiny blood vessels in the skin surface that resemble the legs of a spider called spider nevi. When the condition becomes too severe, the patient can develop confusion and drowsiness that may lead to coma. ^{[1] [3]}

Diagnosis

After a careful medical history and physical examination, a patient is often subjected to laboratory exams. Blood tests may be carried out to measure the liver enzymes, bilirubin levels, bile duct enzymes, protein levels and clotting factors. The patient may also be asked to undergo tests that detect hepatitis viruses and antibodies. Imaging tests like ultrasound and CT scan are helpful especially to gauge the liver size. Depending on the case, a liver biopsy may be recommended. ^[1]

Treatment

Management depends upon the cause and the patient’s condition. The goal is to prevent progression to cirrhosis and liver failure. Mild cases of hepatitis B and C may not need any intervention. Antiviral medications like interferon alpha and ribavirin are used to treat viral hepatitis. For autoimmune type, corticosteroids and other drugs are necessary. Those with alcoholic hepatitis need complete abstinence from liquor. Patients with NASH need weight losing regimens. If the condition progressed to cirrhosis or liver failure, liver transplant may be necessary. Supportive care is at all times a key in coping for patients with chronic hepatitis.  ^[1]

References:

1.      http://www.drugs.com/health-guide/chronic-hepatitis.html

2.      http://www.merckmanuals.com/home/liver_and_gallbladder_disorders/hepatitis/chronic_hepatitis.html

3.      http://www.patient.co.uk/doctor/Chronic-Hepatitis.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Selenium Supplement [1, 12, 13, 14, 15, 16, 17, 18, 19, 20]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. IMPORTANT: Selenium is toxic in high doses. Massive overdoses can cause kidney failure, breathing difficulty and death. Selenium should only be taken at healthy levels which the body is able to tolerate.

Recommendation: No recommendation (Available evidene does not support claims that selenium helps to prevent or treat hepatitis)

Grade of Evidence: very low of evidence

Licorice (Glcyrhiz Gaba) [1, 8, 9, 10, 11]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Licorice has been shown to have potentially harmful side effects in people with high blood pressure, liver or kidney diseases)

Recommendation: Weakly in favor (Small studies and laboratory tests show that Licorice may help in the treatment of chronic hepatitis, but more research is needed)

Grade of Evidence: low quality of evidence

Germanium (Germanium Sesquioxide, Vitamin O) [1, 5, 6, 7]:

WARNING: Germanium may cause permanent Kidney failure. Even organic supplements, though less toxic than inorganic supplements, have caused kidney and liver damage. NOT TO BE USED.

Recommendation: strongly against (Evidence shows that Germanium is not effective in treating hepatitis in any way, and is also toxic, causing severe kidney and liver damage.)

Grade of Evidence: moderate quality of evidence

Chlorella (Green Algae, Chlorella Pyrenoidosa) [1, 2, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Chlorella helps to treat hepatitis in any way)

Grade of Evidence: very low quality of evidence

Neural Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is no evidence that Neural therapy helps treat hepatitis in any way)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org