On the occasion of World Hepatitis Day, July 28, gastroenterologist and hepatologist Harish Peshwe decodes the disease, some strains of which can develop lethal conditions in patients

NT BUZZ

The monsoons can trigger a plethora of illnesses, one of which is acute viral hepatitis, an inflammation of the liver caused by a viral infection.

According to Harish Peshwe, a gastroenterologist and hepatologist at Goa’s Healthway Hospital, acute viral hepatitis is a disease which has various sub-types namely A, B, C, D, and E. While A and E are transmitted through faeco-oral route (unclean food, water), B and C are through blood transfusions, injections, sexual intercourse, using contaminated needles and syringes. Hepatitis D is a co-infection for hepatitis B.

Broadly speaking, hepatitis is ideally divided into two broad categories, acute and chronic. Acute hepatitis as the name suggests is something that causes inflammation of the liver in a short duration of time. (A and E). The symptoms are mainly low grade fever, persistent vomiting, nausea, and jaundice (yellowish discoloration of eyes and urine). The common variety of jaundice seen is either hepatitis A or E. Hep A is seen in childhood whereas in adults the jaundice is usually due to Hep E. Some patients also experience intense itching on skin. In rare cases, if it gets complicated it can cause liver failure and can lead to coma, bleeding from multiple sites, blood vomiting and even death, says Peshwe. In some cases liver transplantation is the only alternative.

Chronic hepatitis is caused by hepatitis B and C. Fatigue, anorexia, loss of weight, and constitutional symptoms predominate in chronic type, says Peshwe. The disease can lead to cirrhosis of liver and complications like liver cancer, blood vomiting, and eventual death. “In South East-Asia, liver cancer is generally caused due to chronic hepatitis B,” says Peshwe. Chronic hepatitis C virus infection could also lead to development of Type 2 diabetes mainly due to insulin resistance, which can further lead to mild obesity.

But hepatitis is not always caused by an external infection. It can also slip into a patient through his or her gene-pool causing something called as autoimmune hepatitis and this requires detailed testing and may result in serious consequences if not treated on time. “There are also certain types of hepatitis which are hereditary. But they are mainly seen in children. They however are rare cases,” says Peshwe.

Vaccination offers a preventive option; the efficacy rate stands at around 95 per cent. Vaccination against hepatitis B can be live-saving, says Peshwe. “Hepatitis B vaccines are available freely and are inexpensive. This is important because Hepatitis B infection can lead to cancer. It’s one of the few vaccines that can be marketed as a vaccine that can help avoid liver cancer in the long run. It’s also added in the paediatric schedule. Vaccines for hepatitis C and E are still in trials,” he says.

Attempting to clear myths and misconceptions about hepatitis, Peshwe says that one of the most common myths is that jaundice in a patient means hepatitis or liver diseases. “Any condition that causes a rise in serum bilirubin can cause jaundice because the pigment gets deposited in the eyes. Jaundice has a variety of causes like blood disorders (Thalassaemia, Haemolytic anaemia, etc) and one among them is hepatitis. Hepatitis is the liver condition that causes jaundice,” he says.

Dispelling myths is necessary because often quacks and local healers indulge in potentially harmful methods to ‘cure’ hepatitis like branding the patient with a hot rod in the belief that the resultant boil will absorb the jaundice. Nothing can be further from the truth, as branding can cause serious life threatening infections in such patients.

“Hepatitis A and E do not get transmitted by casual contact. Hepatitis B is infective, but it is transmitted through blood. Breastfeeding or touching doesn’t cause transmission of hepatitis B as commonly believed by many,” he says.

Some of the risk factors which could lead to an acute viral hepatitis infection are “poor hygiene, drinking unclean water and eating uncooked/improperly vegetables and consuming juices with ice from contaminated water sources,” he adds.

Contrary to a popular belief that certain types of food should be avoided when one is down with hepatitis, Peshwe proposes that one should eat what one can tolerate and all that is healthy as it is promotes recovery. “Due to inflammation of the liver, the person doesn’t feel like eating anyway. As the patient starts to get better, it’s important that the patient gets the necessary nutrients. The patient should be allowed to eat any kind of food. Restricting the patient from eating food may hamper early recovery,” he says.