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These pages present advanced research that is still not universally accepted and treatments not evaluated by the FDA - disclaimer.
Statistics say that 10 - 20 % of chronic liver disease in the US is cryptogenic i.e. of unknown cause ( idiopathic ). The information here, presented in the form of current research abstracts, lets you take a step further and closer to a treatable diagnosis. Research is your best chance to avoid a highly likely progression to a more serious disease.
If you have been diagnosed with the above disease, please make sure that other known and treatable types of chronic hepatitis have been ruled out.
Most of the research you'll find here was obtained searching the web and medical journals on-line for keywords of your interest. MEDLINE search tips.
Your disease can be a hidden( occult or surreptitious ) infection with a known( HBV or HCV ) virus. Here are some papers covering detection of an occult infection. Conclusion is that if serological or viremia indications of HBV or HCV were not found in your blood serum, it is worth looking for them in peripheral blood mononuclear cells( PBMCs ), in the whole blood, and liver tissue obtained during biopsy. Recent research shows that detecting infection in PBMCs may be a good clinical marker to predict relapse after interferon treatment since they appear to be reservoirs for reinfection leading to reactivation of the liver disease. Also, if the evidence of previous HBV infection is present, check HDV (suspecting continuing occult HBV infection undetectable in serum). Here are some labs that can help you in this.
Experts agree that the cause of majority non-B, non-C chronic hepatitis cases( excluding metabolic and alcohol / drug - induced hepatitis) is either viral or autoimmune. Antiviral therapy for hepatic viruses with interferon alfa (IFN-alpha) has been reported to exacerbate autoimmune hepatitis (AIH), whereas corticosteroids for AIH increase viral replication in chronic hepatitis C. Here are some studies that try to differentiate between the two causes. Some autoimmune patients may have low titer of anti-HCV while viral infection is known to provoke autoimmune response presented with autoantibodies in serum of genetically predisposed patients, so final determination should be done with the help of proposed international autoimmune hepatitis group scoring system.
A strong body of evidence supports a viral etiology for chronic hepatitis in the presence of HBV related and HCV related diseases: mixed cryoglobulinemia, rheumatic manifestations and fibromyalgia, and dermatologic disorders: oral lichen planus , sialoadenitis and vasculitis.
Another diagnosis that you may have been given is NonAlcoholic SteatoHepatitis( NASH ). Usually associated with obese or diabetic patients, in the absence of either it becomes another kind of cryptogenic hepatitis. Roughly 1/3 of all abdominal Ultra Sound tests reveal fatty liver( with steatosis ), but differential diagnosis needs to be confirmed on biopsy. Since the cause is unknown, and infections by all known hepatic viruses present with steatosis and increased ferritin as NASH, a viral origin can be suspected.
Apart from viral or autoimmune origin, bacterial and parasitic infections are currently investigated as a cause of cryptogenic chronic hepatitis.
Some more exotic and rather rare diagnosis in chronic liver disease. Most cases are examples of "empirical treatment", where the exact origin of the disease is still unknown to science, but probable therapy was issued. For monitoring the progression of your liver desease, there may be an alternative to painful and risky biopsy.
TREATMENT:
For viral hepatitis we have interferon, ribavirin, amantadine, famciclovir, iron reduction / phlebotomy.
For autoimmune we have prednisone, azathioprine, …
For bacterial and parasitic hepatitis we have treatments as indicated in associated papers.
General helper therapies may include Ursodeoxycholic acid, Sylimarin, glutathione, vitamin B-12.
Finally, now that you have been through all the standard test, tried the advanced ones mentioned on these pages, and are still undiagnosed and untreated, what should you do? Chronic active hepatitis has been shown to have 50% mortality rate over 3 to 5 years, and you really don't have time to waste, especially since the chances of a cure are highest in the beginning. Get treated - research shows that starting with immunosuppressive terapy can either lead to improvement, or in case of worsening switching to viral drugs like IFN usually helps - it is that simple( harder is to find a doctor willing to try empirical treatment ).
Good luck!
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