Hepatitis The danger to the liver

In Germany about one million people live with a chronically inflamed liver

08/19/2013

It is not uncommon for people suffering from liver disease to be suspected of being addicted to drugs or alcohol. About one million Germans live with an inflamed liver and usually do not know about it. In most cases, the disease goes unnoticed. The doctor is consulted only when the infection has progressed so far that complications occur.

The Deputy Chairman of the German Liver Foundation, Professor Stefan Zeuzem, regrets the ignorance of most infected people. „There is a widespread ignorance about contagion paths and healing prospects. Despite medical advances, this can have fatal consequences for these patients“, he notes. Chronic liver diseases such as cirrhosis and cancer are often due to infections with hepatitis B or C viruses.

Fatal consequences for fellow human beings
„We assume that 60 to 80 percent of those affected do not know about their infection“, explains Zeuzem. „They run the risk of infecting others and developing serious sequelae.“ But medical progress in particular today promises good chances of recovery if the infection is recognized early. Hepatitis B infections can be treated so well with medication that the risk of liver damage can be greatly reduced.

The liver suffers unnoticed for a long time
„If clearer symptoms such as jaundice, severe upper abdominal pain, vomiting, and extreme fatigue occur, as many as 90 percent of liver cells are damaged“, says Professor Ulrike Protzer, Director of the Institute of Virology at the Technical University of Munich. „Early detection is therefore extremely important.“

The medical profession is aware of five different hepatitis viruses (hepatitis A - E), all of which enter the body via different transmission pathways. Hepatitis -A is the most prevalent infection. The HAV occurs in Southeast Asia, Russia, the Middle East, the Mediterranean, Africa, Central and South America and is often brought along by travel from these countries. One speaks also of the classical motion sickness. The transmission path is often food or contaminated water. Also by direct contact between humans a contagion is possible. „The infection manifests itself through fever and jaundice and usually heals on its own“, says Protzer. „It does not become chronic, but in rare cases can lead to acute liver failure.“ One can protect oneself before beginning of journey by a vaccination. Especially when traveling to southern and eastern European countries, it is advisable to go to the doctor. Tomas Jelinek, scientific director of the Center for Travel Medicine in Dusseldorf.

Hepatitis E is also transmitted through food and water. In Germany, however, it occurs only sporadically. „However, you should not underestimate them“, warns Protzer. „The virus can be transmitted through non-cooked pork and cause fatal liver failure during pregnancy.“ With hepatitis B, C and D viruses you get infected by the contact with blood or body fluids. The most contagious is the hepatitis B virus. This can be transferred at birth from the mother to the child. „In most cases, the infection goes unnoticed and heals in more than 90 percent of adults on its own“, says Zeuzem. In about 10 percent of infected people, the disease can become chronic. A vaccine against hepatitis B is recommended in infancy. Anyone staying in developing countries for longer periods of time advises Jelinek to get vaccinated before the start of the journey.„Although the risk of infection in hepatitis B can be better controlled by behavior than in hepatitis A.“, he says. „However, the probability of having to be treated medically under poor hygienic conditions increases with the number of trips.“

Hepatitis D viruses occur only in combination with B viruses. They use their shell for propagation. With about 30,000 people affected, the disease is quite rare in Germany, but the courses are usually difficult.

Hepatitis C viruses are rarely transmitted through sexual contact, but almost exclusively through blood. Common uses of hypodermic needles, non-sterile tattooing needles, and piercings are considered a risk, for example. „60 to 80 percent of the diseases become chronic“, warns Zeuzem. There is no vaccine against this type because the virus is highly variable.

Beware of elevated liver values
An infection is considered to be chronic if it is still detectable in the body after 6 months. Here also the efficiency of the immune system plays a crucial role. „If the defense reaction is strong enough, the infected liver cells are destroyed and the viruses are removed from the body“, explains Ulrike Protzer. Disease can be detected by certain enzymes that are produced during the breakdown of liver cells. Even with slight cell damage, the so-called GPT value (glutamate pyruvate transaminase) is increased and indicates an infection. „The medical guideline recommends that you always check for hepatitis B and C viruses at elevated GPT scores“, emphasizes Stefan Zeuzem. „Even people with an increased risk of transmission should be tested.“ These are above all those who received a blood transfusion before 1990 or were once treated under poor hygiene conditions.

Good chances in early detection
You can prove a hepatitis infection by a simple blood test. Unlike in the US, there is no general screening in Germany so far. „In the process, such screening would save considerable costs and expensive long-term therapies and many liver transplants would be avoidable through the early detection of hepatitis infections“, Zeuzem is sure. The chances of a cure for chronic hepatitis C infected see the professor in a few years in 95 percent. „Here is just a therapy revolution in progress“, he enthuses, referring to new antiviral drugs that are about to be approved. First of all, however, patients still have to put up with lengthy therapies, frequent injections and severe side effects.

Patients suffering from chronic hepatitis B can not hope for a successful cure for the time being. „However, we can avoid major damage by controlling the infection through long-term medication“, says Ulrike Protzer. This is where medicines are used that are also used in HIV infections.

The lifestyle can also be partly responsible
However, viruses are not always the cause of liver disease. Often, this is due to the personal lifestyle: Every third adult over 40 has a fatty liver, which is often due to the lifestyle. Above all, people with obesity, diabetes or regular alcohol consumption are affected. „As overweight and malnutrition occur more frequently, in Germany we expect an increase in fatty liver hepatitis in the future“, says Zeuzem. „Even today, two to four percent of the population is likely to be affected.“ In this case, only weight loss, diet change and regular exercise help. „Who already has liver disease“, stresses Ulrike Protzer, „should definitely avoid any further damage.“

Risk factors for hepatitis
Body contact: Hepatitis B, C and D are transmitted through blood and body fluids. In unprotected intercourse, there is a major risk of contracting hepatitis B. In hepatitis C sexually transmitted infections are much less common.

The wrong foods: Hepatitis A and E are transmitted through contaminated foods and contaminated drinking water. Particularly risky is the consumption of shellfish and shellfish.

Lifestyle as risk: About one third of all liver diseases are due to increased alcohol consumption. Obesity and diabetes favor fatty liver hepatitis with the associated risks of cirrhosis and liver cancer. (Fr)

Picture credits: Jörg Klemme, Hamburg