What is hepatitis (inflammation of the liver) and how can it be treated?

What is hepatitis?

Hepatitis means inflammation of the liver. There are several different types of hepatitis with a variety of causes.

July 28th is World Hepatitis Day, a global initiative to raise awareness and educate people about this common condition. The World Health Organisation (WHO) estimates that 354 million people worldwide live with hepatitis B or C.

In this blog, we will take a closer look at hepatitis, including the different types of hepatitis, hepatitis symptoms, what causes hepatitis, and how the condition is treated.

Types of hepatitis

There are five types of viral hepatitis (hepatitis caused by a viral infection), hepatitis A, B, C, D, and E. Types of hepatitis not caused by viruses include alcoholic hepatitis and auto-immune hepatitis.

Hepatitis A

• Is caused by the hepatitis A virus
• Is commonly spread by food and drink contaminated with the faeces (poo) of an infected person
• Is most common in developing countries with poor sanitation
• Hepatitis A is an acute (short-term) infection that usually gets better without treatment within a few months. Occasionally it can be severe and may be life-threatening
• There's no cure for hepatitis A. Treatment aims to relieve symptoms like nausea, pain, and itching.
• A vaccine against hepatitis A is available. The vaccine is recommended if you:
  • Are at high risk of infection with hepatitis A, or are likely to become very sick if you contract the virus
  • Are travelling to a part of the world where the hepatitis A virus is common, such as Africa, the Indian subcontinent, Central and South America, the Far East, and Eastern Europe.

Hepatitis B

• Is caused by the hepatitis B virus
• Is spread through the blood or bodily fluids of an infected person and may be passed:
  • from pregnant women to their babies
  • from frequent, close child-to-child contact
  • through unprotected sex
  • by injecting drugs
• Can be acute or chronic:
  • Acute hepatitis B usually affects adults. There are often no symptoms, and you may be unaware that you have it. In some cases, you may experience mild, flu-like symptoms. Most adults with acute hepatitis B recover within six months without any treatment
  • Chronic hepatitis B lasts longer than six months and usually starts in childhood. Untreated, chronic hepatitis B can lead to cirrhosis and liver cancer. It is treated with antiviral medications
• In the UK, the hepatitis B vaccine is part of the routine immunisation programme offered to all babies. The vaccine is also recommended for people at high risk of contracting hepatitis B including:
  • healthcare workers
  • intravenous drug users
  • men who have sex with men
  • children born to mothers with hepatitis B
  • people travelling to parts of the world where hepatitis B is more common such as southeast Asia, China, and sub-Saharan Africa

Hepatitis C

• Hepatitis C is caused by the hepatitis C virus
• Can be acute or chronic:
  • Acute hepatitis C - a short-term condition from which most people recover without treatment
  • Chronic hepatitis C - the infection stays in your body long-term and can lead to cirrhosis, liver cancer and liver failure
• Is spread through blood-to-blood contact with an infected person through sharing needles, razors, or toothbrushes. It can also be passed from a mother to her unborn baby and rarely, through unprotected sex.
• Hepatitis C may have no symptoms or vague, flu-like symptoms, and many people are unaware that they have it
• Chronic hepatitis C is treated with antiviral medicines
• There is currently no vaccine against hepatitis C

Hepatitis D

• Hepatitis D is caused by the hepatitis D virus
• Hepatitis D only affects people already infected with hepatitis B as it needs the hepatitis B virus to replicate inside your body
• Hepatitis D is spread through direct contact with blood or bodily fluids
• Around 5% of people with hepatitis B are also infected with hepatitis D
• Infection with both chronic hepatitis B and hepatitis D can increase your risk of serious liver problems like cirrhosis and liver cancer
• There's currently no vaccine against hepatitis D, but the hepatitis B vaccine offers some protection against the hepatitis D virus

Hepatitis E

• Hepatitis E is caused by the hepatitis E virus
• Cases of hepatitis E have increased in developed countries in recent years, and it is currently the most common cause of acute hepatitis in the UK
• In the UK, most cases of hepatitis E occur due to eating raw or undercooked meat or shellfish. It can also be spread through contaminated water in parts of the world with poor sanitation
• Most people recover from hepatitis E within a few months, but the virus can be dangerous for pregnant women, the elderly, and people with chronic illnesses or a weakened immune system
• There is currently no vaccine for hepatitis E

Alcoholic hepatitis (Alcoholic liver disease)

• Is the most common type of liver disease in the UK and accounts for six out of ten cases
• Does not usually have any symptoms until the late stages of the disease
• Can lead to cirrhosis, liver failure, or liver cancer
• You can reduce your risk of developing alcoholic hepatitis by drinking alcohol within the recommended safe limits

Autoimmune hepatitis

• Is a rare type of chronic hepatitis that occurs when your immune system mistakenly attacks your liver causing inflammation and liver damage
• The cause of autoimmune hepatitis is unknown, but it is often associated with other autoimmune disorders
• Is treated with medications that suppress your immune system and reduce inflammation

What causes hepatitis?

Hepatitis can have several causes, depending on the type of hepatitis. Hepatitis A, B, C, D and E are caused by a viral infection. Alcoholic hepatitis is a result of alcohol misuse, and autoimmune hepatitis occurs due to an autoimmune disorder where your body attacks its own cells.

What are the symptoms of hepatitis?

Symptoms of hepatitis vary from person to person and depend on the type of hepatitis you have.

You may not experience symptoms of chronic hepatitis such as alcoholic hepatitis until your liver damage is severe, which may not be for many months or years.

Symptoms of acute hepatitis usually occur shortly after contracting a hepatitis virus. In some cases, such as with acute hepatitis B, you may not have any symptoms and may be unaware that you have the virus.

Symptoms of hepatitis may include:

• flu-like symptoms
• dark-coloured urine
• pale, clay-coloured stool (poo)
• abdominal pain and tenderness, particularly on the upper right side
• loss of appetite
• nausea and/or vomiting
• fatigue
• unexplained weight loss
• jaundice (yellowing of the skin and the whites of the eyes)
• abdominal swelling (ascites)

How is hepatitis diagnosed?

To diagnose hepatitis, your consultant will start by asking you about your symptoms, general health, medical history, lifestyle, and any medications you are taking.

They will perform a physical examination, including pressing gently on your abdomen and around your liver to check for pain or tenderness and to see if your liver feels enlarged. They will also check your skin and eyes for signs of jaundice.

To confirm your diagnosis, or to rule out other causes of your symptoms, your consultant will order some tests to check for signs of liver disease and to see how well your liver is working. These may include:

• blood tests - including liver function tests (LFTs) and blood tests to check for viral hepatitis
• abdominal ultrasound - allows your consultant to examine your liver and nearby organs and check for abnormalities such as liver damage, fluid build-up in your abdomen, liver tumours or an enlarged liver
• a liver biopsy - involves taking a sample of tissue from your liver. The sample is sent to the laboratory for analysis.

Hepatitis treatment

Treatment for hepatitis depends on the type of hepatitis you have and whether it is acute or chronic.

• Hepatitis A - normally gets better on its own within three to six months. Your consultant may give you medication to help relieve symptoms such as pain, itching, and vomiting
• Hepatitis B - acute hepatitis B gets better on its own within six months. Chronic hepatitis B is treated with antiviral medications
• Hepatitis C - acute and chronic hepatitis C is treated with antiviral medications
• Hepatitis D - is usually treated with a type of medication called pegylated interferon alpha. Though it doesn’t cure hepatitis D, it may slow the progression of liver damage. Pegylated interferon alpha can cause significant side effects and is not suitable for everyone
• Hepatitis E - usually gets better on its own without treatment in around four to six weeks. Patients with hepatitis E are advised to rest, drink plenty of fluids, eat a nutritious diet, and avoid alcohol and medications that can aggravate the liver such as paracetamol. Pregnant women with hepatitis E should be monitored closely and may need further treatment
• Autoimmune hepatitis - is initially treated with high-dose corticosteroids that suppress your immune system and reduce inflammation as well as other immunosuppressant drugs
• Alcoholic hepatitis - the main treatment for alcohol-induced hepatitis is to stop drinking alcohol. Depending on the severity, it may be possible to reverse liver damage in the early stage. Some people may need inpatient treatment in a hospital or rehabilitation clinic for monitoring and support while quitting alcohol. Treatment for alcoholic hepatitis may include:
  • psychological support such as cognitive behavioural therapy (CBT) and support groups like Alcoholics Anonymous
  • a nutritious diet
  • sedatives such as benzodiazepines to help with symptoms of alcohol withdrawal
  • medication to help you abstain from alcohol like acamprosate and disulfiram
  • corticosteroids to reduce liver inflammation
  • a liver transplant may be necessary if your liver no longer functions (liver failure)

Can hepatitis be prevented?

Hepatitis can’t always be prevented, but there are many things you can do to reduce your risk of getting hepatitis including:

• get vaccinated if you are at high risk of getting hepatitis (vaccines are available for hepatitis A and B)
• reduce exposure to blood and bodily fluids by not sharing needles, razors, or toothbrushes and practising safe sex
• practice good hygiene such as frequent hand washing and safe food preparation
• take precautions to avoid contracting hepatitis when traveling to a country with a high prevalence of the disease

Summary

Hepatitis is a common disease worldwide that causes inflammation of the liver. There are several different types of hepatitis with various causes and treatments. Being informed and aware of how hepatitis is spread is vital to minimise your risk and prevent the spread of this potentially serious disease.