Hepatitis

Hepatitis is a term used to describe inflammation (swelling) of the liver. It can occur as the result of a viral infection or because the liver is exposed to harmful substances such as alcohol.

Some types of hepatitis will pass without causing permanent damage to the liver.

Other types can persist for many years and cause scarring of the liver (cirrhosis). In the most serious cases, it may lead to loss of liver function (liver failure) or liver cancer, which can both be fatal. These types of long-lasting hepatitis are known as chronic hepatitis.

Initial symptoms of hepatitis caused by infection are similar to the flu and include:

muscle and joint pain
a high temperature (fever) of 38ºC (100.4ºF) or above
feeling sick
being sick
headache
occasionally, yellowing of the eyes and skin (jaundice)

Symptoms of chronic hepatitis can include:

feeling unusually tired all the time
depression
jaundice
a general sense of feeling unwell

In many cases hepatitis causes no noticeable symptoms, so when hepatitis is caused by a virus, many people are unaware they are infected.

Similarly, many people with hepatitis caused by alcohol are unaware that their drinking is harming their liver.

Types of hepatitis

The most common types of hepatitis are described below.

Hepatitis A

Hepatitis A, caused by the hepatitis A virus, is the most common type of viral hepatitis. It occurs in the UK, but is more common in countries where sanitation and sewage disposal are poor.

Around 350 cases are reported each year in England, with most cases occurring in people who have travelled abroad.

Hepatitis A is usually caught by putting something in your mouth that has been contaminated with the faeces of someone with hepatitis A.

It is usually a short-term (acute) infection and symptoms will pass within three months. There is no specific treatment for hepatitis A other than to relieve symptoms.

A vaccination can protect you against hepatitis A. Vaccination is recommended if you are travelling to countries where the virus is common, such as the Indian subcontinent, Africa, Central and South America, the Far East and Eastern Europe.

Hepatitis B

Hepatitis B is caused by the hepatitis B virus. This can be found in blood and body fluids, such as semen and vaginal fluids, so it can be spread during unprotected sex, by sharing needles to inject drugs, and from pregnant women to their babies.

Hepatitis B is uncommon in England and cases are largely confined to certain groups, such as drug users. It is much more common in other parts of the world, particularly East Asia and sub-Saharan Africa.

Most people infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months.

However, a small minority of people develop a long-term infection. This is known as chronic hepatitis B. In some people, chronic hepatitis B can cause cirrhosis and liver cancer.

Chronic hepatitis B is treatable with antiviral medication.

A vaccination is available for preventing hepatitis B, which is recommended for people in high-risk groups, such as injecting drug users or healthcare workers.

Hepatitis C

Hepatitis C is the most common type of viral hepatitis in England. It is estimated that around 215,000 people in the UK have chronic hepatitis C.

Hepatitis C is caused by the hepatitis C virus. This can be found in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person.

It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact.

In England, it's most commonly spread through sharing needles to inject drugs, which account for 9 out of 10 cases.

Hepatitis C often causes no noticeable symptoms, or symptoms that are mistaken for the flu, so many people are unaware they are infected.

Around one in four people will fight off the infection and will be free of the virus. In the remaining three out of four people, the virus will stay in their body for many years. This is known as chronic hepatitis C. In some people, chronic hepatitis C can cause cirrhosis and liver failure.

Chronic hepatitis C can be treated by taking antiviral medications, although there can be unpleasant side effects.

There is currently no vaccination for hepatitis C.

Alcoholic hepatitis

Drinking excessive amounts of alcohol over the course of many years can damage the liver, leading to hepatitis. This type of hepatitis is known as alcoholic hepatitis.

It is estimated that as many as one in four moderate to heavy drinkers has some degree of alcoholic hepatitis.

The condition does not usually cause any symptoms and is often detected with a blood test.

If a person with alcoholic hepatitis continues to drink alcohol, there is a real risk that they will go on to develop cirrhosis and possibly liver failure.

Read more about alcoholic liver diseases and the health risks associated with alcohol.

Rarer types of hepatitis

Hepatitis D

Hepatitis D, caused by the hepatitis D virus, is only present in people already infected with hepatitis B (it needs the presence of the hepatitis B virus to be able to survive in your body).

Chronic hepatitis D can increase the risk of cirrhosis developing. Cirrhosis is more likely to develop in someone with chronic hepatitis B becoming infected with hepatitis D (superinfection). It is much rarer when both infections occur together (co-infection).

Infection rates in the UK are low.

Hepatitis E

Hepatitis E, caused by the hepatitis E virus, is very rare in the UK and is generally a mild and short-term infection.

It is caught by putting something in your mouth that has been contaminated with the faeces of someone with hepatitis E. Person-to-person transmission is rare.

See the British Liver Trust website to find out more about hepatitis E.

Autoimmune hepatitis

Autoimmune hepatitis is a very rare cause of chronic (long-term) hepatitis. The white blood cells attack the liver, causing chronic inflammation and damage. This can lead to more serious problems, such as liver failure. The reason for this reaction is unknown.

There are an estimated 10 to 17 cases of autoimmune hepatitis for every 100,000 people in Europe.

Between the ages of 15 and 25, women are around three to four times more likely to be affected than men. However, in older age groups, both men and women are similarly affected.

Symptoms include tiredness, pains in your abdomen, joint aches, jaundice (yellow tinge to your skin and whites of your eyes) and cirrhosis. See your GP immediately if you show any of these symptoms so that tests can be carried out for an early diagnosis.

Treatment for autoimmune hepatitis involves medicines that help suppress the immune system and reduce inflammation (immunosuppressants). Steroid medication (prednisolone) can gradually reduce the swelling over several weeks and can then be used to control your symptoms.

See the British Liver Trust website for more information about autoimmune hepatitis.