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Chronic cryptogenic hepatitis in childhood is unrelated to hepatitis G virus
1Department of Pediatrics, University of Naples Federico II, Italy. riorio@unina.it
Insights
Childhood chronic cryptogenic hepatitis (CCH) is typically symptomless, presenting as isolated high liver enzymes with mild liver damage. Hepatitis G virus is not a major cause of this condition in children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Virology
Background:
- Chronic cryptogenic hepatitis (CCH) in children is poorly understood.
- Identifying the characteristics and potential causes of CCH is crucial for diagnosis and management.
Purpose of the Study:
- To define the clinical and histological features of childhood CCH.
- To investigate the potential association between CCH and hepatitis G virus (HGV) infection.
Main Methods:
- Studied 46 children diagnosed with CCH based on elevated alanine aminotransferase (ALT) levels for over 6 months.
- Assessed clinical presentation, liver function tests, autoimmunity markers, and liver biopsy results.
- Tested for hepatitis G virus RNA in serum.
Main Results:
- CCH in children is largely asymptomatic, characterized by isolated hypertransaminasemia.
- Liver histology showed minimal to moderate chronic hepatitis.
- Hepatitis G virus RNA was detected in only 4% of patients, suggesting it's not a primary cause.
Conclusions:
- Childhood CCH is a generally benign, symptomless condition with mild liver lesions.
- Spontaneous remission is uncommon, but the disease appears nonprogressive in the short term.
- Hepatitis G virus infection does not play a significant role in the pathogenesis of childhood CCH.
Objectives:
The aim of this study was to define the features of chronic cryptogenic hepatitis (CCH) in childhood and to investigate whether it is related to hepatitis G virus infection.
Methods:
Forty-six children (24 males; age range, 1.5 to 17 years) with CCH were studied. CCH was diagnosed when serum alanine aminotransferase concentrations were more than 1.5 times normal for longer than 6 months without any apparent cause of liver disease.
Results:
No patient had acute symptomatic onset or had received a blood transfusion. Three had undergone minor surgical procedures. All appeared to be healthy during follow-up (median, 4.2 years; range, 1 to 10 years). Hypertransaminasemia was the only aberrant liver function test. Elevated serum alanine aminotransferase values alternated with normal values in 40 children (86.9%). Five children (10.8%) had a spontaneous sustained (>12 months) remission of hypertransaminasemia. Twelve (26%) had laboratory signs of autoimmunity, but none fulfilled the criteria for autoimmune hepatitis. Of 20 children who underwent liver biopsy, 13 (65%) had minimal chronic hepatitis, 4 (20%) had mild chronic hepatitis and 3 (15%) had moderate chronic hepatitis. Serum hepatitis G virus RNA was detected in 2 girls (4%) whose risk factor was a hepatitis G virus-infected mother and a minor surgical procedure, respectively. In 12 families at least 1 other member had chronic liver disease.
Conclusions:
Childhood CCH seems to be a symptomless disease characterized by isolated hypertransaminasemia with onset during the first 4 years of life and mild to moderate histologic liver lesions. Although the frequency of spontaneous remissions is low, childhood CCH seems, in the short run, to be a nonprogressive disease. Hepatitis G virus does not play a major role in CCH.