Histological classification of chronic hepatitis

The 1968 classification of chronic hepatitis distinguished cirrhotic and non-cirrhotic stages, and classified the disease according to the histological degree of disease activity into chronic persistent and chronic aggressive (active) varieties. This seemed appropriate at a time when the aetiology of chronic hepatitis was unknown, and presumed to be auto-immune. Immunosuppressive treatment was reserved for more severe variant of the disease, thus validating the usefulness of the classification. Over the past thirty years, several aetiologies were discovered for chronic hepatitis: the hepatitis viruses B, D, C, and G, side-effects of several therapeutic drugs, and autoimmune hepatitis. This progress created a growing need for a new or adapted classification of chronic hepatitis, since different aetiologies require divergent therapeutic approaches. In 1994, proposals for a new classification of chronic hepatitis came from two international organizations: the International Association for the Study of the Liver and the World Congresses of Gastroenterology. The essence of the proposals includes: primary classification according to aetiology, and determination of disease severity (grading) and stage of progression (staging). Several semiquantitative scoring systems for histological grading and staging of liver biopsies from patients with chronic hepatitis are available. Semiquantitative scoring is useful in the evaluation of new treatment regimens, and in comparing pre- and posttreatment biopsies. It is not indicated in the routine reporting of liver biopsies.