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The incidence of chronic active hepatitis in Norway. A retrospective study
Insights
This study on chronic active hepatitis (CAH) in Norway found a higher disease activity than previously reported. The identified etiological agents and patient demographics also differed from other studies.
Area of Science:
- Hepatology
- Gastroenterology
- Epidemiology
Background:
- Chronic active hepatitis (CAH) is a significant liver disease with various causes.
- Understanding the incidence, etiology, and clinical presentation of CAH is crucial for patient management.
- Previous studies have reported varying etiological factors and disease characteristics.
Purpose of the Study:
- To determine the incidence and etiological spectrum of chronic active hepatitis (CAH) in Norway.
- To describe the clinical characteristics and demographic features of CAH patients.
- To compare findings with previously published CAH studies.
Main Methods:
- A nationwide survey of internal medicine departments in Norway was conducted.
- Data on new CAH cases diagnosed in 1981 were collected via questionnaires, histological reports, and discharge summaries.
- Diagnostic criteria were rigorously applied to confirm CAH cases.
Main Results:
- 58 out of 63 reported cases were confirmed as CAH.
- Identified etiological agents included HBsAg-positive (6), alcohol-induced (2), and drug-induced (1); 49 cases were idiopathic.
- The overall incidence of CAH was 1.41 per 100,000, with idiopathic CAH at 1.19 and HBsAg-positive CAH at 0.15.
- Idiopathic CAH patients were older (mean age 51, one-third ≥65), frequently had autoantibodies (71%), and elevated aminotransferase levels (61% >5x, 46% >10x upper reference range).
- The etiological profile and disease activity (aminotransferase levels) differed from other studies, suggesting a potential selection bias towards more severe cases.
Conclusions:
- The etiological distribution and disease activity in Norwegian CAH patients differ from international reports.
- Higher aminotransferase levels suggest more pronounced disease activity, possibly due to the inclusion of only severe cases.
- Further research is needed to elucidate the specific factors influencing CAH presentation and severity in Norway.
Abstract:
From all departments of internal medicine in Norway information has been collected about new cases of chronic active hepatitis (CAH) diagnosed during 1981. A questionnaire together with copies of histological examination reports and discharge summaries have been carefully examined to ensure that established diagnostic criteria were fulfilled. Of the 63 reported cases, 58 were recorded as CAH. An aetiological agent was identified in nine cases; six were HBsAg-positive, two were alcohol-induced, and one drug-induced. The other 49 cases were assumed to be idiopathic. The incidence of CAH of all causes was 1.41 per 100,000; of idiopathic CAH, 1.19 per 100,000; and of HBsAg-positive CAH, 0.15 per 100,000. The mean age was 51 years, and a third of the patients in the idiopathic group were 65 years or older at presentation. In this group about 71% of the patients had autoantibodies, and 61% had serum aminotransferase levels more than five times and 46% more than ten times the upper reference range. The proportion of the different aetiological agents was different from what has been reported in other studies. The activity of the disease, judged by the serum level of aminotransferase, was more pronounced than reported in other investigations. This may indicate that only relatively severe cases of CAH were subjected to liver biopsy.