Chronic active hepatitis: the spectrum of disease

A five-year study of all newly diagnosed cases of chronic active hepatitis (CAH) from a defined population of 404,000, in which the internationally accepted diagnostic criteria were applied, is reported. A putative aetiological agent was identified in all but 14 (23%) of 61 cases. Alcohol (26%) and hepatitis B (20%) were the commonest aetiological factors. The incidence of CAH was 3 per 100,000 per year. Patients were often elderly, mean age 56, with a third aged over 65. A third were symptom-free at diagnosis, and the disease was biochemically or histologically severe in only a few. 9 of 61 (15%) fulfilled the criteria for treatment used in the Mayo Clinic trials. Even after exclusion of those with CAH unresponsive to corticosteroids (i.e., where hepatitis B, drugs, alcohol are involved in the aetiology) and widening of the criteria, only 7 of the remaining 31 (23%) are likely to benefit from corticosteroids. The variety of aetiological agents, spectrum of clinical features, and range of disease severity are very different in an unselected group from those reported from specialised referral centres.