Chronic hepatitis is inflammation of the liver that lasts for more than six months. In most cases, it is caused by the hepatitis B virus.
However, chronic hepatitis can also be caused by the hepatitis C or D viruses, excessive alcohol use, or autoimmune diseases, for example. In many cases, chronic hepatitis does not cause clear symptoms and is often found during routine testing.
Some people may have symptoms such as general malaise, decreased appetite, or frequent tiredness for no clear reason. Even when it does not cause symptoms, hepatitis should always be treated, as it can worsen and lead to serious complications, such as cirrhosis or liver failure.
Main symptoms
According to the CDC, many people with viral hepatitis have no symptoms and may not realize they are infected.
Symptoms of chronic hepatitis may appear gradually as liver inflammation develops. The main symptoms are:
-
Nausea
-
Vomiting
-
Swollen abdomen
-
Redness on the palms of the hands
-
Yellowing of the skin and eyes
-
Persistent general malaise
-
Decreased appetite
-
Frequent tiredness for no clear reason
-
Persistent low-grade fever
-
Discomfort in the upper right side of the abdomen
Chronic hepatitis is often discovered during routine blood tests, which may show changes in AST and ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase, or bilirubin levels.
Confirming a diagnosis
If a healthcare provider suspects chronic hepatitis, they may order more specific blood tests to check liver enzymes and antibodies. Imaging tests, such as an ultrasound or CT scan, may also be requested.
In some cases, a liver biopsy may be needed. This test involves removing a small sample of liver tissue and sending it to a laboratory to help confirm the cause of hepatitis and assess how much liver damage is present, which can help guide treatment.
Possible causes
In many cases, chronic hepatitis is caused by infection with the hepatitis B virus. According to the World Health Organization (WHO), hepatitis B can become chronic and may lead to serious liver disease, including cirrhosis and liver cancer.
However, other relatively common causes include:
- Hepatitis C virus
- Hepatitis D virus
- Excessive alcohol use
- Autoimmune diseases
Although less common, chronic hepatitis can also be caused by certain medications, especially isoniazid, methyldopa, or phenytoin. When this happens, switching medications is usually enough for the liver inflammation to improve.
Treatment options
Treatment for chronic hepatitis depends on the cause and on how much the liver has been damaged. In some cases, treatment may begin with a corticosteroid to reduce inflammation and improve symptoms while the exact cause is still being investigated.
Once the cause is identified, treatment is adjusted to cure the disease when possible and to prevent complications. For hepatitis caused by hepatitis B or C, the doctor may prescribe antiviral medications. If it is related to an autoimmune disease, treatment for that condition should be started. When hepatitis is due to excessive alcohol intake or certain medications, alcohol or the offending drug should be stopped.
At the same time, complications related to worsening inflammation, such as encephalopathy or fluid buildup in the abdomen, may also need treatment.
In more severe cases, when liver damage is very advanced, a liver transplant is usually required.