Physician Focus Print: Understanding Hepatitis

Physician Focus: November 2013
by Albert Crimaldi, M.D., Ph.D. and Maggie Ham, M.D.

Physician Focus - Dr. Ham and Dr. Crimaldi
Albert Crimaldi, MD, Ph.D. and Maggie Ham, MD

Affecting millions of Americans, hepatitis is a disease of the liver, one of the largest organs in the human body that’s responsible for critical bodily functions, such as the clotting of blood, resisting infections, and clearing waste. It is a major cause of liver cancer and a leading cause of death by infection, claiming some 15,000 lives every year.

Understanding this condition requires some insight: the word hepatitis simply means an inflammation of the liver, and the disease can take various forms and result from distinctly different causes.

Hepatitis can be acute (lasting a short time) or chronic (recurring or persistent), and some acute forms can become chronic. It can be viral (caused by a virus) or nonviral (caused by a number of other factors, including genetic disorders, prescription or over-the-counter medications, alcohol, toxins, or even the body’s own immune system). One form is even triggered by the buildup of fat cells in the liver. Illness from the disease can range from mild to severe. Some types require medication; some will clear the body naturally.
 
The viral form is widespread in the U.S. and has five strains (A, B, C, D, and E), each caused by a different virus. The most common types are A (usually caused by contaminated food or water), and B and C (spread by infected blood). According to estimates from the U.S. Centers for Disease Control (CDC), about 70,000 people become infected every year with one type of acute viral hepatitis. In addition, about 1.2 million have chronic hepatitis B, and 3.2 million have chronic hepatitis C – and most of those are unaware they have the disease.
 
The CDC considers “hep C” a major public health threat because so many have the disease. Estimates are that 75 percent of those infected are baby boomers (those born between 1945 and 1965), believed to have contracted the disease in the 1970s and 1980s when the rates of hepatitis C were the highest, prior to both the availability of screening tests to eliminate hepatitis C from the blood supply and the heightened public awareness of hepatitis C virus transmission through high-risk activities such as IV drug use. Public health officials are urging everyone in that group to get tested, as testing is the only way to discover if the virus is present. Most people who get hepatitis C – a leading cause of liver cancer and the most common reason for liver transplants - end up with a chronic form of the illness.

Hepatitis C raises special concern because patients often can live for decades with the condition and exhibit no signs of the disease.  While acute symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, and jaundice, many with hepatitis C do not manifest acute symptoms, and testing is critical to discover those unknowingly in the chronic phase of this infection.

While viral hepatitis captures much attention, a nonviral type, NASH, is rapidly gaining ground. NASH (nonalcoholic steatohepatitis), also called fatty liver disease, occurs when the liver becomes overpopulated with fat cells, usually caused by too much fat from a poor diet. Fatty liver disease is becoming more prevalent with high rates of obesity, so much so that this type is soon likely to surpass viral hepatitis as a common cause of liver transplants. Along with obese individuals,   those with diabetes, high cholesterol, or high triglycerides (a measure of fat cells in the blood) are at higher risk for this type of hepatitis.
Risk factors for hepatitis include a history of intravenous drug use and anything that involves the potential of blood transfer. Taking too much medication, either prescription or over-the-counter, can also lead to liver damage, and tattoos and body piercing, which may present risks from unsanitary needles, can be contributing factors as well.

Good treatments are available for hepatitis, but prevention, as with so much in health care, remains the best strategy. Leading a healthy lifestyle, and steering clear of the risks and toxins that can inflame the liver are the best preventive steps. Avoiding heavy use of alcohol is particularly important, because overuse can cause cirrhosis, or scarring of the liver, that results in liver damage and subsequent liver malfunction.  Proper diet and exercise play a big role in reducing the risk for fatty liver disease, while vaccines are available for the viral strains A and B.

For more information on hepatitis, visit the CDC website at www.cdc.gov/hepatitis. For a video discussion, visit www.physicianfocus.org/hepatitis.

Albert Crimaldi, M.D., Ph.D., and Maggie Ham, M.D. are gastroenterologists at Milford Regional Medical Center in Milford, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org  

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