Toxic hepatitis is caused by certain chemicals, drugs and excessive consumption of Giloy and Triphala without consulting an Ayurveda doctor. It can cause liver failure. Dr Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta Hospital, Gurgaon, demystifies the jargon for World Hepatitis Day.
How can we distinguish between acute and chronic hepatitis?
Acute hepatitis resolves within a few days and 95 percent of them recover completely. The two most common manifestations of acute hepatitis are hepatitis A and E – both of which are spread through contaminated water and food. Now if someone has yellow eyes, excessively yellow urine and reports a deranged liver function test (LFT), they may be suffering from hepatitis A or E. You don’t need to panic – with supportive treatment, the condition will improve. Resolve in two-three weeks and the patient will be fine. The liver will heal completely.
However, chronic hepatitis is more serious. In India, there are four causes of chronic hepatitis. One is related to alcohol. Then there is non-alcoholic fatty liver disease (NAFLD) which can lead to hepatitis B and C. Alcoholic hepatitis develops when someone drinks too much alcohol for more than seven to eight years, meaning more than 14 units a week and more in men. Ten units a week for women. Each unit of alcohol can be measured as a glass of wine, a mug of beer or 30 ml of whiskey. Alcoholic hepatitis initially presents itself as fatty liver. When that fatty liver becomes inflamed, it is called hepatitis. If excessive alcohol is still consumed, it can lead to fibrosis, cirrhosis, liver failure and liver cancer. So, to avoid this, moderate your alcohol intake.
Other types of hepatitis arise from NAFLD which is found in people with obesity, diabetes, poor lipid profile and high cholesterol. NAFLD is present in approximately 35 percent of all adults. But 20 percent of these patients will eventually develop liver inflammation, and half of them will progress to early stages of scarring and fibrosis. Half of those with fibrosis then progress to cirrhosis and, if persistent and uncontrolled, liver failure.
The obvious way to prevent hepatitis due to NALFD is to control diabetes, cholesterol and weight. Avoid a sedentary lifestyle, ensure 30 minutes of exercise a day, eat a healthy diet and ensure you don’t lack movement.
Hepatitis B and C are two viral infections that are transmitted through blood or bodily fluids, much like AIDS. In fact, it can be transmitted through needles, syringes, dialysis machines, infected blood and sexual contact. It can be prevented by vaccination. But there is no vaccine for hepatitis C, so precautions must be taken to prevent its spread through body fluids and blood. These two viruses are much better controlled now than they were ten years ago, and because of that, effective drugs are available for hepatitis B and C, along with the hepatitis B vaccine. Therefore, their prevalence has decreased.
What is toxic hepatitis?
Toxic hepatitis is an injury to the liver caused by the ingestion of certain chemicals, drugs, or medicines. This is one of the most common causes of acute liver failure. Sometimes it can be a reaction to a drug that damages the liver, sometimes it can be caused by an overdose. Ingestion of toxins can cause liver injury, inflammation and liver failure. About 15 to 20 percent of liver poisoning patients develop liver failure and the rest recover easily if they stop using toxic substances. A person suffering from toxic hepatitis should always consult a liver specialist.
What are the symptoms?
All types of hepatitis have the same symptoms, such as jaundice and body itching. However, if the liver fails, water accumulates in the body and blood can be seen in vomit, urine or stool – water accumulates in the stomach, legs and stomach of a person. In more advanced cases, people can suffer from encephalopathy, which means that the effects of a severely inflamed and damaged liver can be seen on the brain, causing drowsiness, confusion and aggression. Some people may become comatose or unconscious. Some early symptoms of toxic hepatitis are tiredness and fatigue. After that, jaundice begins to develop.
Who is more sensitive to it? What are the risk factors?
Toxic hepatitis can happen to anyone at any age because its occurrence mainly depends on the consumption of toxic substances. It can be any person, a child between 10-15 years old, a young adult or an elderly person. So, first and foremost, the important thing to understand is the cause. In India, the primary cause, which is known in most cases, is overdose of anti TB drug/drugs. Approximately, 18 percent of all liver transplants are due to overdose of anti-TB drugs. Additionally, excessive consumption of complementary and alternative (CAM) medicines such as herbal and Ayurvedic blends, giloy and triphala herbs can also lead to liver failure. During the epidemic, we have reported many cases of liver damage due to excessive consumption of Giloy without consulting Ayurvedic experts or doctors. This has occurred in people with healthy livers and especially in people with unreported autoimmune liver disease. Also, people who take bodybuilding supplements and anabolic steroids are at risk of liver damage.
How can toxic hepatitis be managed?
Symptoms such as fatigue and jaundice can be managed by early recognition of toxic hepatitis in those who have ingested substances that provoke it. Such people should see a liver doctor and undergo tests for timely diagnosis. Treatment involves specific liver therapy, including stopping toxic drugs. In extreme cases, the patient may require hospitalization and a liver transplant. About 80-90 percent of patients recover with adjuvant treatment but a small percentage may develop severe liver disease and may even require a liver transplant due to late diagnosis and treatment. The protocol mainly follows standards for prevention of liver damage drugs, management of jaundice and liver damage, liver protocols in special liver units that include counteractive drugs, hepatic encephalopathy and antibiotics, if they have superinfection. The doctor may prescribe medications that lower bilirubin, and in some cases, prostaglandins may be given. A liver dialysis may be necessary.
How can we prevent serious liver conditions?
The first and foremost prevention is early diagnosis. This means being regular with your liver function tests. Follow it up with prothrombin time detection and ultrasound. If any chronic liver disease is suspected, endoscopy, CT scan and a liver biopsy are performed. Preventive measures may also include understanding drugs and anabolic steroids that can damage the liver and stopping their consumption.
People should make sure that they take medicines as prescribed by the doctor and in limited amounts. Similarly, herbs and Ayurvedic medicines should also be taken within safe limits as prescribed by a skilled Ayurvedic practitioner. People should avoid consuming over the counter medicines without consulting and consulting a doctor. Take the appropriate dose without limiting the amount. And if one is taking anti-tubercular drugs, he/she should follow a regular protocol including liver function tests every two weeks.
What is the prevalence of hepatitis in India? What are the challenges of its treatment and diagnosis?
In rural areas, expertise and facilities for diagnosis and treatment of hepatitis may not be available. In that case people travel to big cities or now they seek online help – 70 percent of India’s major hospitals in most of the country’s major hospitals are connected through the Internet to online facilities. So, patients can tele-consult and get help online. Usually, if hepatitis is suspected, the doctor will ask you to do liver function tests, do an abdominal ultrasound, sometimes do a fibrosis scan and prescribe medications to treat early cases of hepatitis. But once hepatitis has progressed to significant liver damage, scarring, and cirrhosis, it may not be completely reversible.
The world is currently facing a new outbreak of unexplained acute hepatitis infection affecting children. What are the possible causes? What do you think are the chances of such an outbreak in India?
Globally, there are many cases of undiagnosed cases of hepatitis in children and these are associated with Covid infection. India is also seeing these cases in children two months after exposure to COVID-19. About a third of these children have a history of having been infected with Covid, usually two to three months ago, while other children may have been infected with Covid through their parents and family members but have never been infected themselves. Typically, what happens is that these children develop jaundice, nausea, loss of appetite, report elevated levels in liver function tests (LFT) and, in extreme cases, severe liver disease and liver failure. But usually it is not serious. In only 10 to 15 percent, patients develop complete liver failure and may not survive in the ICU or liver transplant unit. Usually associated hepatitis will be treatable with special care by liver specialists and the child will usually respond to medication.
What are the preventive measures for non-fatty liver?
Healthy lifestyle – Non-alcoholic fatty liver disease can be avoided by maintaining a good diet, sugar control, weight, lipid profile and cholesterol. Make sure you get enough exercise and drink enough water. Eat a balanced nutritious diet with olive oil, grains and pulses, fish. Avoid processed foods, red meat, overly sweet foods and excessive alcohol. Hepatitis B can be prevented by vaccination. Hepatitis C can be prevented by ensuring that all medical facilities screen blood at the blood bank, use disposable needles and syringes, and use cleaning protocols for dialysis machines. If someone is known to be infected with hepatitis B and C, they may be sexually transmitted. Therefore, the sexual partner should use a barrier method of contraception.