Dubbed the “silent epidemic”, millions are unknowingly living with the disease. If you are unsure of your condition, consider consulting a hepatologist.
When the liver is already burdened with dealing with the hepatitis virus and its various functions, any further stress can worsen the situation for your liver and yourself.
HEADING: The ABCs of (viral) hepatitis
“A common misconception people have about hepatitis is that once they get given this label, that’s it, they’re doomed, they’re dying as the liver is now failing. Hepatitis does not necessarily mean liver failure. Liver failure means the liver is losing or has lost all its function.”
“So what’s hepatitis?”
“Hepatitis really just means “inflamed liver”. It doesn’t specify any further. Causes are many. It could be from viruses, trauma, genetic issues, blood pressure changes, medication, fatty liver, alcohol and so many more,” says Dr Prabhjot Singh Sidhu, Consultant Gastroenterologist, Hepatologist and Physician at Ara Damansara Medical Centre
As the second largest organ after your skin, the liver plays a vital role in the body’s immune function by detoxifying chemicals and metabolising drugs. Although hepatitis has multiple causes and is broadly defined, the main types of hepatitis generally known to the public are hepatitis A, B, and C. “.. and these belong to the viral hepatitis group of causes of a hepatitis,” Dr Prabhjot adds.
Dr Prabhjot comments that the level of awareness regarding all hepatitis and its effects remains a global problem particularly as its often asymptomatic.
“Although some panic on hearing the word, a large number of people who know they have a hepatitis do little or nothing about it unless instructed by their doctors. Let’s also not forget about the existing lack the sense of urgency to consult doctors in the first place on said hepatitis of which its worth mentioning again its asymptomatic nature in the beginning is part to blame. The other part would often be due to poor understanding on the immediate and long term effects of having a hepatitis. There is also another group of people worth highlighting and it’s those who decide to take un-vetted medication in hopes to self-treating their hepatitis. This is very dangerous behaviour and could even worsen their existing liver disease”
In comparison, “the heart” with all of its symptoms, public awareness campaigns and general public fear of dying of a heart attack has led to early and better screening programmes which then translates to prevention, early detection and early treatment.
Your body recovers naturally
Dr Prabhjot shares, “As not all hepatitis’ are the same, so it must be reflected in its management. This is true even within the realm of viral hepatitis.”
For example, in adults, hepatitis A and acute hepatitis B infections are mostly self-limiting. Given enough time, the majority (not all) of patients will recover naturally without medical intervention and in this majority, if medication is needed it is only as a supportive measure to manage the symptoms.
Chronic hepatitis B on the other hand may require medication to control the virus and its corresponding inflammation if set out specific criteria are met. “why only if criteria are met? Well, in very simple terms, the body keeps the hepatitis B virus “in check” and only when control is lost (leading to liver injury) or if significant liver damage exists do you need treatment. As it is the commonest cause of liver cancers (lifetime risk is 25 to 40%) keeping hepatitis B “in check “is very important. Why “in check” rather than cure? That’s because once chronically infected the virus cannot be completely removed from infected cells. The goal is to prevent liver damage by keeping the virus “in check” and by that, keeping liver cancer at bay. As control of the virus can be lost at any time often with other illnesses or if immunosuppressed, but also often with no warning at all, continued follow up with a hepatologist even when all is well is warranted,” he explains “.. you are also more likely to develop Chronic Hepatitis B if infected early in life vs as an adult. Up to 95% chance of chronic infection new-borns vs 5% as healthy adults,” he continues. He adds that hepatitis B patients who live with other diseases (co-infections) such as hepatitis C and HIV also have a higher likelihood of getting liver cancer. “Hepatitis C sits on the other side of things with very effective treatment already available and being delivered. It can and should be treated if found.”
Consulting a hepatologist
When? “Any hepatitis would benefit from a review from a hepatologist but with reference to the “ABCs” of (viral) hepatitis, there is no better time than now. If there is concern, get a review. Often only a simple blood test is needed,” explained Dr Prabhjot. “A few examples for a need of a review in this context would be:”
- A family history of hepatitis B or C
- A family history of liver disease/cancer
- If a patient is known to have a viral hepatitis of any type even with normal liver function test (LFTs).
- Risky behaviour in the past (tattoos and intravenous drug use for example)
- Having abnormal liver function and unknown viral hepatitis status.
- Other liver disease already present
“We would rather review the patient early and initiate the appropriate steps early than tell them they should have come to us a long time ago.”
SIDEBAR: Learning the differences
Although belonging to the viral hepatitis group, hepatitis A, B and C differ from one another.
Dr Prabhjot Singh Sidhu, Consultant Gastroenterologist, Hepatologist and physician at Ara Damansara Medical Centre, notes that among the hepatitis viruses, hepatitis B is the most common form of hepatitis among Asians as well as the most worrisome.
Currently, it affects one-third of the global population and up to half a billion people have chronic infections. Most people are unaware that they have the condition.
Dr Prabhjot adds that co-infection of Hepatitis B and Hepatitis D occurs in about 15% of those with hepatitis leading to chronic Hepatitis D infection that affects around 90% of patients. The hepatitis D can replicate by itself but needs the hepatitis B antigen to spread.
Hepatitis D makes the hepatitis B virus more aggressive, harder to treat and also reduces the effectiveness of treatment for hepatitis B. Co-infections between hepatitis B and D is considered the most severe form of chronic viral hepatitis due to more rapid progression towards liver-related death and hepatocellular carcinoma (liver cancer).
BOX: A dangerous cocktail
If you have a viral hepatitis, you should avoid any activity that can “stress” the liver further, such as excessive alcohol consumption, certain prescribed medication, herbal medicines and diet. The liver is struggling, so give it a chance to heal.
For more information, call 03-5639 1212.
As featured on The Star Newspaper, 19 May 2020.
