conditions hepatitis

RECND534

Hepatitis

Condition:Hepatitis
Other:HAV, HBV, HCV
ICD-10 Codes:B15-B19

Summary

Top 3 supplements for hepatitis:

1. licorice (Glycyrrhiza glabra)
2. milk thistle (Silybum marianum)
3. N-acetylcysteine (NAC)

Naturopathic Treatments

Avoid:
• alcohol
• tylenol
iron
• processed foods
• fatty foods (esp. trans fats)

Consume:
• cruciferous vegetables
garlic (Allium sativum)
• green tea
• olive oil
• grapefruit

Supplements
• N-acetylcysteine (NAC)
• glutathione
• S-Adenosyl methionine (SAMe)
betaine

Botanicals (internal)
• Minor Bupleurum Fromula (e.g. Sho-saiko-to; Xiao Chai Hu Tang)
- Contraindincated during iterferon therapy
licorice (Glycyrrhiza glabra)
milk thistle (Silybum marianum)
• reishi (Ganoderma lucidum)
• sun mushroom(Agaricus blazei)
schisandra (Schisandra chinensis)
astragalus (Astragalus propinquus; Astragalus membranaceus)
• chanca piedra (Phyllanthus amarus; Phyllanthus niruri)
• mistletoe (Viscum album)
caterpillar fungus (Cordyceps sinensis)
agrimony (Agrimonia eupatoria)

Topical
• castor oil packs

Conventional Treatments

Prevention
• vaccinations for hepatitis A and B

Hepatis A virus
• no treatment (self-limiting)

Hepatis B virus
antiviral drugs
- lamivudine
- adefovir
- tenofovir
- telbivudine
- entecavir
• interferon
- interferon alpha-2a
- PEGylated interferon alpha-2a

Hepatis C virus
• interferon (pegylated interferon alpha)
antiviral drug
- ribavirin
- boceprevir
- telaprevir

Signs & Symptoms

Acute
flu-like sx (fever, muscle/joint aches, malaise, nausea and vomiting, diarrhea, headache)
• loss of appetite
• dark urine
• jaundice
• abdominal discomfort
• hepatomegaly
• splenomegaly
• lymphadenopathy

Chronic
• malaise
• fatigue and weakness
• hepatomegaly
• jaundice
• peripheral edema
• ascites
• cirrhosis

DDx

• systemic lupus erythematosus
• autoimmune hepatitis
cholelithiasis
• cholecystitis
• inflammatory bowel disease (IBD, e.g. ulcerative colitis)
• tumours (e.g. hepatocellular carcinoma)
fatty liver (alcoholic, non-alcoholic)
• drug-induced hepatitis (e.g. paracetamol, tetracycline)
• non-viral hepatitis (e.g. syphilis, schistosomiasis)
• infiltration (e.g. amyloidosis)
• chronic birth control or OCP use
• heart failure
hepatic congestion (e.g. Budd-Chiari syndrome)
• biliary disease (e.g. sclerosing cholangitis)
• Wilson s disease
• metabolic disease (e.g. glycogen storage disease, hemochromatosis)
• liver abscess
• alpha-1 antitrypsin deficiency

Pathogenesis

Hepatitis A virus (HAV)
• one human serotype
• RNA virus replicating exclusively in the liver
• contracted by fecal-oral route
• does not progress to chronic infection

Hepatitis B Virus (HBV)
• DNA-containing hepadnavirus
• includes HbsAg, HBeAg, hepatitis B core antigen
• contracted through exchange of bodily fluids (e.g. blood, mucus);

Hepatitis C Virus (HCV)
• flavivirus
• small, single-stranded RNA virus targeting the liver
• not easily contracted through exposure to bodily fluids of an infected individual
• may progress to chronic infection

Hepatitis D Virus (HDV)
• requires co-infection or superinfection with (established) HBV
• RNA-containing virus with delta protein antigen and coated with hepatitis B surface antigen
• contracted through bodily fluid exchange

Hepatitis E Virus (HEV)
• single-stranded RNA virus
• contracted by fecal-oral route
• does not progress to chronic infection

Hepatitis G Virus (HGV)
• single-stranded RNA virus
• contracted through transfusions or organ transplants
• does not progress to chronic infection

Risk Factors
• exposure to persons or areas prevalent with hepatitis virus
• shared needles
alcoholism
• certain medications
• immunocompromised individuals
• received a blood transfusion or organ transplant before 1990
• sexual contact

Diagnostics

• physical exam
• subjective hx
• notify public health if infected with hepatitis virus

Diagnostic Tests
• blood test
• serologic and molecular tests
• HAV: IgM anti-HAV, IgG anti-HAV
HBV: biopsy, hepatitis B panel
HCV: anti-HCV, HCV RNA
• HDV: HBsAg, anti-HDV, IgM anti-HBc, IgG anti-HBc
• HEV: IgM anti-HEV, IgG anti-HEV
• HGV: PCR assay (however not readily available)

References

"Show references"

"Hide references"

Hsu CH, Hwang KC, Chiang YH, Chou P. The mushroom Agaricus blazei Murill
extract normalizes liver function in patients with chronic hepatitis B. J Altern
Complement Med. 2008 Apr;14(3):299-301. doi: 10.1089/acm.2006.6344. PubMed PMID:
18370584.

Grinde B, Hetland G, Johnson E. Effects on gene expression and viral load of a
medicinal extract from Agaricus blazei in patients with chronic hepatitis C
infection. Int Immunopharmacol. 2006 Aug;6(8):1311-4. Epub 2006 May 11. PubMed
PMID: 16782544.


Wang BE. Treatment of chronic liver diseases with traditional Chinesemedicine. J Gastroenterol Hepatol. 2000 May;15 Suppl:E67-70. PubMed PMID:10921385.

Wang M, Cheng H, Li Y, Meng L, Zhao G, Mai K. Herbs of the genus Phyllanthusin the treatment of chronic hepatitis B: observations with three preparationsfrom different geographic sites. J Lab Clin Med. 1995 Oct;126(4):350-2. PubMedPMID: 7561442.

PMID: 12212155 [PubMed - indexed for MEDLINE]

Wang MX, Cheng HW, Li YJ, Meng LM, Mai K. [Efficacy of Phyllanthus spp. intreating patients with chronic hepatitis B]. Zhongguo Zhong Yao Za Zhi. 1994Dec;19(12):750-1, 764. Chinese. PubMed PMID: 7718142.

Melhem A, Stern M, Shibolet O, Israeli E, Ackerman Z, Pappo O, Hemed N, Rowe M, Ohana H, Zabrecky G, Cohen R, Ilan Y. Treatment of chronic hepatitis C virus infection via antioxidants: results of a phase I clinical trial. J Clin Gastroenterol. 2005 Sep;39(8):737-42. PubMed PMID: 16082287.

Kim K, Kim KH, Kim HY, Cho HK, Sakamoto N, Cheong J. Curcumin inhibitshepatitis C virus replication via suppressing the Akt-SREBP-1 pathway. FEBS Lett.2010 Feb 19;584(4):707-12. Epub 2009 Dec 17. PubMed PMID: 20026048.

Kim HJ, Yoo HS, Kim JC, Park CS, Choi MS, Kim M, Choi H, Min JS, Kim YS, Yoon SW, Ahn JK. Antiviral effect of Curcuma longa Linn extract against hepatitis Bvirus replication. J Ethnopharmacol. 2009 Jul 15;124(2):189-96. Epub 2009 May 3. PubMed PMID: 19409970.

Lukita-Atmadja W, Ito Y, Baker GL, McCuskey RS. Effect of curcuminoids asanti-inflammatory agents on the hepatic microvascular response to endotoxin.Shock. 2002 May;17(5):399-403. PubMed PMID: 12022761.

Moreno-Otero R, Trapero-Marug Á n M. Hepatoprotective effects of antioxidants inchronic hepatitis C. World J Gastroenterol. 2010 Apr 21;16(15):1937-8. PubMedPMID: 20397276; PubMed Central PMCID: PMC2856839.

Sotelo N, de los Angeles Durazo M, Gonzalez A, Dhanakotti N. Early treatmentwith N-acetylcysteine in children with acute liver failure secondary to hepatitisA. Ann Hepatol. 2009 Oct-Dec;8(4):353-8. PubMed PMID: 20009135.

McCartney EM, Semendric L, Helbig KJ, Hinze S, Jones B, Weinman SA, Beard MR. Alcohol metabolism increases the replication of hepatitis C virus and attenuates the antiviral action of interferon. J Infect Dis. 2008 Dec 15;198(12):1766-75.PubMed PMID: 18956976.

Wang N, Shi XF, Guo SH, Zhang DZ, Ren H. [A clinical study ofN-acetylcysteine treatment in chronic hepatitis B patients]. Zhonghua Gan ZangBing Za Zhi. 2008 Jul;16(7):487-9. Chinese. PubMed PMID: 18647523.

Tripi S, Gaetano GD, Soresi M, Carroccio A, Bonfissuto G, Savi A, Vuturo O,Montalto G. Acetylcysteine therapy for chronic hepatitis C: are its effectssynergistic with interferon alpha? A pilot study. Clin Drug Investig.1998;16(4):297-302. PubMed PMID: 18370551.

Neri S, Ierna D, Antoci S, Campanile E, D'Amico RA, Noto R. Association ofalpha-interferon and acetyl cysteine in patients with chronic C hepatitis.Panminerva Med. 2000 Sep;42(3):187-92. PubMed PMID: 11218623.

Freedman ND, Curto TM, Morishima C, Seeff LB, Goodman ZD, Wright EC, Sinha R,Everhart JE; HALT-C Trial Group. Silymarin use and liver disease progression inthe Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial. AlimentPharmacol Ther. 2011 Jan;33(1):127-37. doi: 10.1111/j.1365-2036.2010.04503.x.Epub 2010 Nov 2. PubMed PMID: 21083592.

Payer BA, Reiberger T, Rutter K, Beinhardt S, Staettermayer AF,Peck-Radosavljevic M, Ferenci P. Successful HCV eradication and inhibition of HIVreplication by intravenous silibinin in an HIV-HCV coinfected patient. J ClinVirol. 2010 Oct;49(2):131-3. Epub 2010 Aug 14. PubMed PMID: 20709593.

Wagoner J, Negash A, Kane OJ, Martinez LE, Nahmias Y, Bourne N, Owen DM,Grove J, Brimacombe C, McKeating JA, PÉcheur EI, Graf TN, Oberlies NH, Lohmann V,Cao F, Tavis JE, Polyak SJ. Multiple effects of silymarin on the hepatitis Cvirus lifecycle. Hepatology. 2010 Jun;51(6):1912-21. PubMed PMID: 20512985;PubMed Central PMCID: PMC2909978.

Ahmed-Belkacem A, Ahnou N, Barbotte L, Wychowski C, Pallier C, Brillet R,Pohl RT, Pawlotsky JM. Silibinin and related compounds are direct inhibitors ofhepatitis C virus RNA-dependent RNA polymerase. Gastroenterology. 2010Mar;138(3):1112-22. Epub 2009 Dec 4. PubMed PMID: 19962982.

El-Kamary SS, Shardell MD, Abdel-Hamid M, Ismail S, El-Ateek M, Metwally M,Mikhail N, Hashem M, Mousa A, Aboul-Fotouh A, El-Kassas M, Esmat G, StricklandGT. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomedicine. 2009May;16(5):391-400. Epub 2009 Mar 19. PubMed PMID: 19303273; PubMed Central PMCID:PMC2733865.

Ma WH, Lu Y, Huang H, Zhou P, Chen DF. Schisanwilsonins A-G and relatedanti-HBV lignans from the fruits of Schisandra wilsoniana. Bioorg Med Chem Lett. 2009 Sep 1;19(17):4958-62. Epub 2009 Jul 18. PubMed PMID: 19640714.

Ma WH, Huang H, Zhou P, Chen DF. Schisanwilsonenes A-C, anti-HBV Carotanesesquiterpenoids from the fruits of Schisandra wilsoniana. J Nat Prod. 2009Apr;72(4):676-8. PubMed PMID: 19228000.

Melhem A, Stern M, Shibolet O, Israeli E, Ackerman Z, Pappo O, Hemed N, Rowe M, Ohana H, Zabrecky G, Cohen R, Ilan Y. Treatment of chronic hepatitis C virusinfection via antioxidants: results of a phase I clinical trial. J ClinGastroenterol. 2005 Sep;39(8):737-42. PubMed PMID: 16082287.

Loo WT, Cheung MN, Chow LW. Fructus schisandrae (Wuweizi)-containing compoundinhibits secretion of HBsAg and HBeAg in hepatocellular carcinoma cell line.Biomed Pharmacother. 2007 Oct;61(9):606-10. Epub 2007 Sep 14. PubMed PMID:17904789.

Coon JT, Ernst E. Complementary and alternative therapies in the treatment ofchronic hepatitis C: a systematic review. J Hepatol. 2004 Mar;40(3):491-500.Review. PubMed PMID: 15123365.

Acharya SK, Dasarathy S, Tandon A, Joshi YK, Tandon BN. A preliminary opentrial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in thetreatment of subacute hepatic failure. Indian J Med Res. 1993 Apr;98:69-74.PubMed PMID: 8344734.

Shinada M, Azuma M, Kawai H, Sazaki K, Yoshida I, Yoshida T, Suzutani T,Sakuma T. Enhancement of interferon-gamma production in glycyrrhizin-treatedhuman peripheral lymphocytes in response to concanavalin A and to surface antigenof hepatitis B virus. Proc Soc Exp Biol Med. 1986 Feb;181(2):205-10. PubMed PMID:3080754.

Bjelakovic G, Gluud LL, Nikolova D, Bjelakovic M, Nagorni A, Gluud C.Meta-analysis: antioxidant supplements for liver diseases - the CochraneHepato-Biliary Group. Aliment Pharmacol Ther. 2010 Aug;32(3):356-67. Epub 2010May 22. PubMed PMID: 20497142.

Navarro-AlarcÓn M, LÓpez-Ga de la Serrana H, PÉrez-Valero V, LÓpez-MartÍnezMC. Selenium concentrations in serum of individuals with liver diseases(cirrhosis or hepatitis): relationship with some nutritional and biochemicalmarkers. Sci Total Environ. 2002 May 27;291(1-3):135-41. PubMed PMID: 12150433.

Darvesh AS, Bishayee A. Selenium in the prevention and treatment ofhepatocellular carcinoma. Anticancer Agents Med Chem. 2010 May 1;10(4):338-45.Review. PubMed PMID: 20380634.

Stewart S, Prince M, Bassendine M, Hudson M, James O, Jones D, Record C, Day CP. A randomized trial of antioxidant therapy alone or with corticosteroids inacute alcoholic hepatitis. J Hepatol. 2007 Aug;47(2):277-83. Epub 2007 May 4.PubMed PMID: 17532088.

Li YQ, Wang SF. Anti-hepatitis B activities of ganoderic acid from Ganoderma lucidum. Biotechnol Lett. 2006 Jun;28(11):837-41. Epub 2006 May 31. PubMed PMID: 16786250.

Li Y, Yang Y, Fang L, Zhang Z, Jin J, Zhang K. Anti-hepatitis activities inthe broth of Ganoderma lucidum supplemented with a Chinese herbal medicine. Am J Chin Med. 2006;34(2):341-9. PubMed PMID: 16552843.

Li YQ, Zhang KC. [In vitro inhibitory efects on HBsAg and HBeAg secretion of 3 new components produced by Ganoderma lucidum in the medium contained Radixsophorae flavescentis extract]. Wei Sheng Wu Xue Bao. 2005 Aug;45(4):643-6.Chinese. PubMed PMID: 16245890.

Lin XY, Huang KL, Zhu RP. [Therapeutic effect of Ganoderma applonatum (GA) onchronic hepatitis B]. Zhonghua Nei Ke Za Zhi. 1988 Oct;27(10):618-20, 652-3.Chinese. PubMed PMID: 3229185.

Tusenius KJ, Spoek AM, van Hattum J. Exploratory study on the effects oftreatment with two mistletoe preparations on chronic hepatitis C.Arzneimittelforschung. 2005;55(12):749-53. PubMed PMID: 16430029.

Tusenius KJ, Spoek JM, Kramers CW. Iscador Qu for chronic hepatitis C: anexploratory study. Complement Ther Med. 2001 Mar;9(1):12-6. PubMed PMID:11264964.

Dang SS, Jia XL, Song P, Cheng YA, Zhang X, Sun MZ, Liu EQ. Inhibitory effectof emodin and Astragalus polysaccharide on the replication of HBV. World JGastroenterol. 2009 Dec 7;15(45):5669-73. PubMed PMID: 19960563; PubMed CentralPMCID: PMC2789219.

Wang S, Li J, Huang H, Gao W, Zhuang C, Li B, Zhou P, Kong D. Anti-hepatitis B virus activities of astragaloside IV isolated from radix Astragali. Biol Pharm Bull. 2009 Jan;32(1):132-5. PubMed PMID: 19122295.

Chen H, Weng L. [Comparison on efficacy in treating liver fibrosis of chronichepatitis B between Astragalus Polygonum anti-fibrosis decoction and jinshuibaocapsule]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2000 Apr;20(4):255-7. Chinese.PubMed PMID: 11789260.

Inoue M, Kurahashi N, Iwasaki M, Shimazu T, Tanaka Y, Mizokami M, Tsugane S; Japan Public Health Center-Based Prospective Study Group. Effect of coffee andgreen tea consumption on the risk of liver cancer: cohort analysis by hepatitisvirus infection status. Cancer Epidemiol Biomarkers Prev. 2009 Jun;18(6):1746-53.PubMed PMID: 19505908.

Abe K, Suzuki T, Ijiri M, Koyama Y, Isemura M, Kinae N. The anti-fibroticeffect of green tea with a high catechin content in the galactosamine-injured ratliver. Biomed Res. 2007 Feb;28(1):43-8. PubMed PMID: 17379956.

Morcos PN, Brennan B, Smith PF. A grapefruit a day for patients infected withhepatitis C? Hepatology. 2008 Jun;47(6):2141-2; author reply 2142-3. PubMed PMID:18508304.

Hampton T. Grapefruit compound battles hepatitis C. JAMA. 2008 Apr2;299(13):1532. PubMed PMID: 18387924.

Filipowicz M, Bernsmeier C, Terracciano L, Duong FH, Heim MH.S-adenosyl-methionine and betaine improve early virological response in chronichepatitis C patients with previous nonresponse. PLoS One. 2010 Nov8;5(11):e15492. Erratum in: PLoS One. 2010;5(11). doi:10.1371/annotation/14d47e6a-400a-429e-a487-6dd375e04632. PubMed PMID: 21079746;PubMed Central PMCID: PMC2975710.

Filipowicz M, Bernsmeier C, Terracciano L, Duong FH, Heim MH. S-adenosyl-methionine and betaine improve early virological response in chronic hepatitis C patients with previous nonresponse. PLoS One. 2010 Nov 8;5(11):e15492. Erratum in: PLoS One. 2010;5(11). doi: 10.1371/annotation/14d47e6a-400a-429e-a487-6dd375e04632. PubMed PMID: 21079746; PubMed Central PMCID: PMC2975710.

Haid S, Novodomsk Á A, Gentzsch J, Grethe C, Geuenich S, Bankwitz D, Chhatwal P, Jannack B, Hennebelle T, Bailleul F, Keppler OT, Poenisch M, Bartenschlager R, Hernandez C, Lemasson M, Rosenberg AR, Wong-Staal F, Davioud-Charvet E, Pietschmann T. A plant-derived flavonoid inhibits entry of all HCV genotypes into human hepatocytes. Gastroenterology. 2012 Jul;143(1):213-22.e5. Epub 2012 Mar 27. PubMed PMID: 22465429.

Filipowicz M, Bernsmeier C, Terracciano L, Duong FH, Heim MH. S-adenosyl-methionine and betaine improve early virological response in chronic hepatitis C patients with previous nonresponse. PLoS One. 2010 Nov 8;5(11):e15492. Erratum in: PLoS One. 2010;5(11). doi: 10.1371/annotation/14d47e6a-400a-429e-a487-6dd375e04632. PubMed PMID: 21079746; PubMed Central PMCID: PMC2975710.

Kwon DH, Kwon HY, Kim HJ, Chang EJ, Kim MB, Yoon SK, Song EY, Yoon DY, Lee YH, Choi IS, Choi YK. Inhibition of hepatitis B virus by an aqueous extract of Agrimonia eupatoria L. Phytother Res. 2005 Apr;19(4):355-8. PubMed PMID: 16041735.

Disclaimer: This content is subject to change. The information is intended to inform and educate; it does not replace the medical evaluation, advice, diagnosis or treatment by a healthcare professional. www.healthydigestionclinic.com © 2015 NDAssist Inc. and/or its affiliates. All rights reserved.