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Massachusetts Medical Society's Physician Focus

November 2013



  • Hepatitis is a major cause of cirrhosis and liver cancer and a leading cause of death by infection, claiming some 15,000 lives every year.

  • The condition can be caused by a number of factors, including medications, alcohol, fatty deposits in the liver, and viruses.

  • Two of the most common forms of the disease are hepatitis C, a viral infection, and NASH, nonalcoholic steatohepatitis hepatitis, or fatty liver disease.

  • Hepatitis C affects more than three million Americans, yet most do not know they are infected. NASH is becoming more prevalent as obesity rates increase.

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Hepatitis is a disease of the liver, one of the largest organs in the human body that’s responsible for critical bodily functions, such as clotting of blood, resisting infections, and clearing waste. The disease can take various forms and result from distinctly different causes.

While most people may identify hepatitis as an infectious disease, that is only one aspect of the condition. “The term hepatitis,” says Albert Crimaldi, M.D. “simply describes an inflammation of the liver. It does not always connote a viral infection. There are a lot of agents that can cause liver inflammation, or hepatitis, not just viruses.”

Dr. Crimaldi, a board-certified gastroenterologist with Milford Gastroenterology Associates and a staff physician at Milford Regional Medical Center, in Milford, Massachusetts, joined his associate Maggie Ham, M.D. as a guest on the November edition of Physician Focus to discuss the causes, types, and treatment of hepatitis, a prevalent and growing condition in the United States. Hosting this edition is primary care physician Bruce Karlin, M.D.

For patients, understanding hepatitis takes some insight and effort. The disease can be acute (lasting a short time) or chronic (recurring or persistent). It can be viral (caused by a virus) or nonviral (caused by such factors as genetic disorders, prescription or over-the-counter medications, alcohol, toxins, or even the body’s immune system). One form is triggered by the buildup of fat cells in the liver.

Some acute forms can become chronic. Some types will clear the body on their own, and others will need medication. And many times, patients won’t know they have the disease because no symptoms will appear.

Five types of viral hepatitis exist: A, B, C, D, and E, with the most common being A, B, and C. Hepatitis C, however, is having the most impact on public health and the one currently targeted by health officials, as the majority of people who contract hepatitis C end up with a chronic illness. The U.S. Centers for Disease Control and Prevention estimates that more than three million Americans have “hep C,” the leading cause of liver cancer and the most common reason for liver transplants. In total, nearly four and half million people are affected by all forms of viral hepatitis.

While the viral versions of hepatitis may capture the most attention, a nonviral type is rapidly gaining ground: NASH, nonalcoholic steatohepatitis, or fatty liver disease. NASH occurs when the liver gets overpopulated with fat cells causing inflammation, which can then progress to hepatitis, or fatty liver disease.

Dr. Ham explains why this type of hepatitis is increasing. “We’re overloading ourselves with fat from poor diets,” she says. “And with the increase in obesity, fatty liver disease is becoming more prevalent.” Because the obesity epidemic is expected to continue, Dr. Ham notes that fatty liver disease is “likely to overtake viral hepatitis in a few years as a common cause of liver transplants.”

So what might patients do to guard against hepatitis? For NASH, it comes down to lifestyle choices. “Diet and exercise play a huge role in reducing the risk for NASH,” says Dr. Ham.

For certain other forms, avoiding toxins that cause inflammation is important. This is especially true of alcohol because it causes a high rate of cirrhosis, or scarring of the liver, which leads to liver damage.

Testing is also key for patients. “Clearly, getting an assessment to find out if there are any liver test abnormalities is imperative,” says Dr. Crimaldi, who also notes that treatments for hepatitis are improving. But he adds that there’s a lot beyond testing that can be done, and he harkens back to a proven, preventive course of action that’s universally recommended by health providers: “Diet, weight loss, and healthy lifestyles,” he states, “can make a big difference.”

Watch the accompanying video for additional conversation, including discussion about the risk factors for viral hepatitis and NASH, the differences between the different viral hepatitis types, and how hepatitis is treated.

MMS/Richard Gulla

U.S. Centers for Disease Prevention and Control

Hepatitis Foundation International

American Liver Foundation

HepC 123

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"Hepatitis" PSA

From left, Bruce Karlin, M.D., Maggie Ham, M.D., Albert Crimaldi, M.D.
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