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Chronic active hepatitis. Experience from a Norwegian reference hospital during a decade
Insights
This study followed 90 chronic active hepatitis (CAH) patients, finding immunosuppressive therapy often necessary but difficult to discontinue. Many patients required reinstitution of treatment, highlighting the chronic nature of CAH.
Area of Science:
- Hepatology
- Immunology
- Gastroenterology
Background:
- Chronic active hepatitis (CAH) is an inflammatory liver disease with significant morbidity.
- Etiologies of CAH include viral infections and drug toxicity, but many cases are idiopathic.
Purpose of the Study:
- To investigate the long-term outcomes and treatment responses in a cohort of hospitalized patients with chronic active hepatitis.
Main Methods:
- Retrospective analysis of 90 hospitalized CAH patients diagnosed between 1971-1980.
- Follow-up until death or end of 1981, with assessment of etiology, complications, and response to immunosuppressive therapy.
Main Results:
- 28% of patients died, primarily from liver disease. 62% experienced complications of portal hypertension.
- 89% showed pronounced biochemical activity, and 93% received immunosuppressive therapy (corticosteroids +/- azathioprine).
- Treatment withdrawal was frequently unsuccessful, with 35/45 patients requiring reinstitution of therapy.
Conclusions:
- Chronic active hepatitis is a severe condition with high mortality and morbidity.
- Immunosuppressive therapy is often required but challenging to discontinue, indicating the chronic and relapsing nature of the disease.
Abstract:
During the decade from 1 January 1971 to 31 December 1980. 90 hospitalized patients fulfilled the diagnostic criteria of chronic active hepatitis (CAH). An aetiological agent was identified in 13 of the patients: hepatitis B virus infection in 6 and a drug in 7. The other 77 cases were assumed to be idiopathic. The mean age at presentation was 32 years, and 66 (73%) of the patients were female. The patients have been followed up until death or until 31 December 1981. The mean observation period was 114 months. Twenty-five (28%) patients died. 19 of them of liver disease. Complications or signs of portal hypertension were observed in 62%. Of the 18 patients with upper gastrointestinal bleeding 15 had a portal-systemic shunt performed. Associated diseases in other organ systems were observed in 16 (18%) of the patients. Pronounced biochemical activity was found in 80 (89%) of the patients. Immunosuppressive therapy was started in 84 (93%), either as corticosteroids alone (40 patients) or in combination with azathioprine (44 patients). Azathioprine was later withdrawn in 29 (66%), in 6 because of side effects and in 20 because of clinical and biochemical improvement. Corticosteroids were withdrawn in 22 (26%), in 2 because of side effects and in 18 because of improvement. In 35 of the 45 patients in whom discontinuation was attempted, the treatment had to be reinstituted. Eight of the patients on combined therapy could discontinue both immunosuppressive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)