Chronic Active Hepatitis: Experience from a Norwegian Reference Hospital during a Decade

Abstract

During the decade from 1 Jan. 1971-31 Dec. 1980, 90 hospitalized patients fulfilled the diagnostic criteria of chronic active hepatitis (CAH). An etiological agent was identified in 13 of the patients: hepatitis B virus infection in 6 and a drug in 7. The other 77 cases were assumed to be idiopathic. The mean age at presentation was 32 yr, and 66 (73%) of the patients were female. The patients have been followed-up until death or until 31 December 1981. The mean observation period was 114 mo. Patients (25, 28%) died, 19 of them of liver disease. Complications or signs of portal hypertension were observed in 62%. Of the 18 patients with upper gastrointestinal bleeding 15 had a portal-systemic shunt performed. Associated diseases in other organ systems were observed in 16 (18%) of the patients. Pronounced biochemical activity was found in 80 (89%) of the patients. Immunosuppressive therapy was started in 84 (93%), either as corticosteroids alone (40 patients) or in combination with azathioprine (44 patients). Azathioprine was later withdrawn in 29 (66%), in 6 because of side effects and in 20 because of clinical and biochemical improvement. Corticosteroids were withdrawn in 22 (26%), in 2 because of side effects and in 18 because of improvement. In 35 of the 45 patients in whom discontinuation was attempted, the treatment had to be reinstituted. Of the patients on combined therapy 8 could discontinue both immunosuppressive drugs. On the basis of the results of the present investigation cessation of immunosuppressive therapy in patients with idopathic CAH is tried after 2 yr of treatment if the patients are in clinical remission and have low activity in the biochemical tests. In the patients who relapse, life-long immunosuppressive therapy is recommended.