[Clinical significance of cholestatic viral hepatitis]

Modern serologic methods permit the classification of the particular course a virus hepatitis takes into individual types of pathogenesis. This is the case with hepatitis A in which only cholestatic courses have been proved for sure. Cholestatic courses are observed in 5-10% of all cases of acute hepatitis A, with variations from country to country. The duration of the disease is considerably longer than in non-cholestatic hepatitis A. It is between 80 and 130 or even more days! The diagnostic difficulty consists in the clear delimination to other diseases, particularly to intrahepatic cholestasis by drugs or to posthepatic stenosis. Sonography and ERCP are useful technological methods in this situation. Specific therapeutical measures are not available due to the lack of knowledge of the pathogenesis of this type of acute virus infection. The prognosis of cholestatic hepatitis A is good. Short-term glucocorticoid therapy is recommended by some authors in long-term cases, which are associated with pruritus, general weakness, loss of weight and distinct icterus. The course of the disease is obviously not changed by this therapy, but the sometimes agonizing symptomatology is relieved.