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Hepatitis is a serious inflammation of the liver, usually due to a virus. It can also be caused by an overactive immune system, and from drugs, alcohol, chemicals, and environmental toxins. In the United States, viral hepatitis usually appears as type A, B, or C. Two other types -- D and E -- are rare in the U.S.
Type A is the most common form of viral hepatitis. It often affects school-aged children. The disease is usually transmitted when someone ingests fecal matter through contaminated food or water. You can also get hepatitis A by having sex with someone who has the virus. A person who has hepatitis A can be contagious before they even know they have the disease. Unlike other forms of viral hepatitis, the virus doesn’t stay in your body once you recover. The best way to prevent hepatitis A is with a vaccine and good hygiene.
Hepatitis types B and C affect people of all ages. Most people who become infected with hepatitis B get rid of the virus within 6 months. This type of short infection is known as an "acute" case of hepatitis B. About 10% of people infected with the hepatitis B virus develop a chronic, life-long infection. People with chronic infection may or may not have symptoms. Those who do not develop symptoms are referred to as carriers. You can get hepatitis B through contact with infected blood and body fluids. Having chronic hepatitis B increases your chance of permanent liver damage, including cirrhosis (scarring of the liver) and liver cancer. There is a vaccine to prevent hepatitis B.
Anyone who has chronic hepatitis B is also susceptible to infection with another strain of viral hepatitis known as hepatitis D (formerly called delta virus). Hepatitis D virus can only infect cells if the hepatitis B virus (HBV) is present. People who use IV drugs are at greatest risk. Being infected with both hepatitis B and D raises the risk of developing cirrhosis or liver cancer.
Hepatitis C is usually spread through contact with infected blood, as when IV drug users share needles. It can be either acute (a short-term infection) or become chronic and even life threatening. There is no vaccine for hepatitis C.
Hepatitis E is rare in the United States. It is spread through ingesting food or water contaminated with feces. There is no vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus.
Signs and Symptoms
People with chronic hepatitis do not always have the symptoms of acute hepatitis. Some people with hepatitis C feel only mild ongoing fatigue and, perhaps, whole body itching. The virus is often discovered by a blood test.
Hepatitis A is usually transmitted by someone touching feces and then not washing their hands before putting them in their mouth or touching food. It can be transmitted by ingesting contaminated food and water (for example, seafood from sewage contaminated water). It can also be transmitted through close contact with someone who has the virus.
Hepatitis B and C are transmitted through contact with infected blood. These viruses are usually transmitted by contaminated needles (in the case of IV drug users). Having unprotected sex with someone who is infected can also pass on the hepatitis B virus (it is rarer for hepatitis C to be transmitted through sexual activity). In as many as 40% of the cases of hepatitis C, the specific cause of transmission is unknown. Before better testing was developed, you could get hepatitis B or C from a blood transfusion. Now blood and blood products that are used for transmission can be tested for both hepatitis B and C.
Many viruses can cause hepatitis, including herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and others.
First, your doctor will ask questions to assess your risk for the different types of viral hepatitis. Questions will include whether you:
Next, your doctor will examine your abdomen carefully to see whether your liver or spleen are enlarged or tender. A blood test will check your liver function and test for antibodies against the specific hepatitis viruses. Your doctor will likely do a urine test as well. For chronic hepatitis, you may need a liver biopsy, which must be done under general anesthesia. A liver biopsy is important if you have chronic hepatitis C because this test checks the degree of liver damage, which can occur even if you don't have symptoms.
Hepatitis B and C
People who should receive the hepatitis A vaccine include:
Immunization provides the only true protection against hepatitis B. The hepatitis B vaccine is now part of routine pediatric care in the United States. Adults who are at higher risk should also be vaccinated:
There is no vaccine for hepatitis C, but immunoglobulin helps protect against it after blood transfusions. Receiving immunoglobulin in periodic doses may also help protect someone who has sex with an infected partner.
The goals for treating acute viral hepatitis include:
There are no medications to treat acute hepatitis, although your doctor may recommend drugs to treat some of the symptoms. Most cases of acute hepatitis are mild. Only people who are at high risk for complications, such as pregnant women, the elderly, people with serious underlying medical conditions, or those who become dehydrated from nausea and vomiting need to be hospitalized. In very rare cases, acute hepatitis can lead to liver failure (called fulminant acute hepatitis) that requires liver transplantation.
The goals for treatment of chronic viral hepatitis include:
There are several medications your doctor can choose to help treat chronic hepatitis. Many people also use CAM therapies that may help boost your immune function and help make you feel stronger and less tired while taking conventional medications, including herbal and vitamin supplements, homeopathy, acupuncture, and massage therapy. Make sure your health care providers know that you have hepatitis so that precautions can be taken to avoid spread of the virus.
Your doctor will talk with you about steps you can take to avoid spreading the virus. For hepatitis A, these include:
For hepatitis B and C, these measures include:
If you are traveling to a high-risk country, take the following precautions:
Interferons -- Interferon is produced by the body to fight viruses. Taking man-made interferons may help stimulate your immune system against the hepatitis B and C viruses. Examples of interferon medications include Roferon-A, Intron-A, Rebetron, Alferon-N, and Peg-Intron. These drugs do not work for everyone who takes them, but the possible benefits include:
Ribavirin (Rebetol) -- often used in combination with interferon for chronic hepatitis C. Side effects can include anemia (low red blood cell count), fatigue, skin irritation, insomnia, and depression. Side effects are usually most severe during the first weeks of treatment, and improve after that.
Lamivudine (Epivir-HBV) -- an oral medication used to stop the hepatitis B virus from reproducing in the body. It has fewer side effects, but some people’s symptoms get significantly worse when they stop taking it.
Adefovir dipivoxil (Hepsera) -- an oral medication used to stop the hepatitis B virus from reproducing in the body, given the people who didn’t respond to Epivir. Like Epivir, side effects are mild but some people’s symptoms get significantly worse when they stop taking it.
Entecavir (Baraclude) -- an antiviral drug taken as a pill once a day to treat hepatitis B. Studies comparing it with Epivir show Baraclude is more effective. As with Epivir, some people’s symptoms get significantly worse when they stop taking it.
Surgery and Other Procedures
People with the following conditions may need a liver transplant:
Five year survival rate after liver transplantation is 60 - 80%. In about 50% of those with chronic hepatitis who receive a liver transplant, the infection recurs.
Nutrition and Dietary Supplements
Although no special diets have been shown to help treat acute hepatitis, eating small snacks during the day, with larger ones in the morning, may be recommended to prevent weight loss and reduce nausea. Generally, eating a healthy diet -- lots of fruits and vegetables high in antioxidants -- can help anyone with a chronic disease.
Do not drink alcohol, especially if you have chronic hepatitis.
Tell your health care provider about any supplements you are thinking about taking.
Herbs are one to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. Some herbs may interact with medications, so ask your doctor before taking any herb. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Cordyceps (Cordyceps sinensis), 3 to 4.5 g twice daily, is a type of mushroom used in traditional Chinese medicine to support the liver. Preliminary studies show it may help improve liver and immune system function in people with hepatitis B. People who have autoimmune disease should not take Cordyceps.
Milk thistle (Silybum marianum, 420 mg per day standardized to 70 to 80% silymarin for cirrhosis; 240 mg, 2 times per day of silibinin for chronic hepatitis) -- Milk thistle has been used since Greco Roman times to treat liver problems. Several scientific studies lend support to this traditional use. They suggest that a substance in milk thistle (silymarin) can protect the liver from damage caused by viruses, toxins, alcohol, and certain drugs, such as acetaminophen. However, studies are mixed as to whether milk thistle improves liver function tests or quality of life for people with chronic active hepatitis B or C. People who are allergic to ragweed may have an allergic reaction to milk thistle. Milk thistle may have estrogen-like effects, so people with hormone sensitive conditions should use this herb with caution. Because it acts on the liver, Milk thistle can theoretically interact with several medications that are processed through the liver.
Milk thistle may help protect the liver against damage from exposure to industrial toxins.
In a comprehensive review of studies on milk thistle by the U.S. Agency for Healthcare Research and Quality (AHRQ), milk thistle improved liver function in people with mild liver disease but did not work as well for those with severe liver disease, such as cirrhosis.
Licorice root (Glycyrrhiza glabra) -- Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses, including liver disease. Preliminary data from Japanese researchers suggests that taking glycyrrhizin (an active component of licorice root) along with cysteine and glycerine might help reduce the risk of cirrhosis if you have hepatitis C and B. However, the formula was delivered intravenously (IV). It is not known whether taking these substances by mouth would have any effect. More studies are needed. People with high blood pressure or those who take steroids, digoxin (Lanoxin), diuretics (water pills), or anticoagulants (blood thinners such as warfarin (Coumadin) should not take licorice. Pregnant women should avoid licorice. Licorice interacts with many medications and can raise blood pressure. Use licorice only under the direction of your physician. People with hormone-sensitive conditions, kidney disease, bleeding disorders, or who are using blood-thinning medications should be particularly cautious with licorice.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg, 2 to 3 times daily, for chronic hepatitis B. A preliminary study showed it decreased levels of the hepatitis B virus, but more study is needed. Reishi may lower blood pressure and interact with blood-thinning medications; speak with your physician.
While research in China has shown some promise in treating hepatitis B, not many acupuncturists in the United States provide treatment for hepatitis. In China, acupuncture is generally used to boost the immune system of those with hepatitis.
There has been some concern that people could contract hepatitis from dirty needles or infected practitioners. However, there have been no reports of infection in the U.S. In many states acupuncturists are required to use sterile needles, and there is virtually no risk of contracting hepatitis from acupuncture therapy here or in other countries with similar standards and safe practices.
Therapeutic massage may help boost the immune system.
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for viral hepatitis based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) is a range of traditional medical practices originating in China that developed over several thousand years. When assessing a person with hepatitis, a TCM practitioner might make one of the following diagnoses:
Once the diagnosis is established, the practitioner is likely to use acupuncture, moxibustion (a burning of an herb called mugwort over acupuncture sites), and herbal drugs to address the imbalances of hepatic qi (energy) and yin yang (balance).
If you are at high risk of contracting hepatitis, or if have already been infected with any form of the hepatitis virus, your doctor will recommend the hepatitis B vaccine. A vaccine is also available for hepatitis A.
Food handlers should be extremely careful of contracting hepatitis A, and health care workers should always exercise universal precautions to avoid contracting or transmitting hepatitis B or C.
Support groups are available for people with chronic hepatitis B or C. It is often difficult to cope with this disease. Talking with people who also have this condition is often very helpful. Check with your doctor or hospital to locate a support group near you.
Hepatitis B and C can be transmitted during pregnancy or childbirth. Women who are pregnant, or planning to become pregnant soon, cannot take interferon or nucleoside analogues.
Warnings and Precautions
Because the liver processes many types of medications, your doctor may tell you to stop taking drugs other than those recommended for treatment of hepatitis. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), used to relieve pain, can raise your risk for serious liver damage.
Some herbs and supplements are known to cause harm to the liver:
Do not take over-the-counter drugs that contain acetaminophen (Tylenol) if you have hepatitis without first talking to your doctor. Acetaminophen can be toxic to the liver, even in people with healthy livers.
Prognosis and Complications
With acute hepatitis, jaundice generally disappears in 2 - 8 weeks. Sometimes you may need to be hospitalized -- for example, if you become dehydrated -- but most people recover completely. It can take several months for your liver function to test normal.
Rare yet serious complications of acute hepatitis include aplastic anemia (when the bone marrow makes no new cells), pancreatitis, very low blood sugar, and polyarteritis (inflammation of blood vessels). Also quite rare is liver failure (called fulminant hepatitis), with bleeding from the gastrointestinal tract and brain damage, known as hepatic encephalopathy. Sometimes the acute phase of hepatitis B or C is milder but longer, with recovery taking up to 1 year. Some 5 - 10% of people who have a longer acute phase go on to develop chronic hepatitis.
Once the acute phase is over, long-term prognosis depends on several things: what caused the hepatitis, whether you become a carrier of hepatitis B or develop chronic hepatitis, and whether you have other medical conditions. About 5 - 10% of people with hepatitis B become carriers, and about 25% of carriers develop chronic hepatitis. Most people infected with hepatitis C become carriers, and anywhere from 50 - 90% of them eventually develop chronic hepatitis.
Chronic hepatitis can cause scar tissue to form in the liver (known as cirrhosis) and lead to liver failure. There are 2 types of chronic hepatitis -- chronic active and chronic persistent. Chronic persistent hepatitis is mild and either doesn't get worse or only does so very slowly. Chronic active hepatitis, on the other hand, is much more likely to lead to permanent damage to the liver. Cirrhosis occurs in 5 - 10% of people with chronic hepatitis from hepatitis B, and as many as 20 - 30% of those with chronic hepatitis from hepatitis C. About 14% of people with cirrhosis develop liver cancer.
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Review Date: 8/16/2013
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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