Idaho Gastroenterology Associates

Diseases of the Pancreas

admin — Thu, 22 Dec 2011 21:40:06 +0000

Diseases of the Pancreas

What is the pancreas?

The pancreas is an organ that is located in the back of the upper abdomen. It is about 6-8 inches long and 2 inches wide. The pancreas has two basic functions; one is to produce the hormone called insulin, which regulates the main sugar glucose in the body. The other is to make enzymes to aid in the digestion of food. These enzymes are secreted into the small intestine via a tube-like structure called the pancreatic duct.

Diabetes and pancreatic insufficiency

When the production of insulin by the pancreas is impaired, diabetes mellitus can result. This can result in high blood glucose levels, which if left untreated, can result in damage to the eyes, heart, kidneys and nerves. It can even eventually lead to coma. Fortunately, many of these problems can be avoided if diabetes is diagnosed and treated properly. Treatment usually consists of dietary modifications and medications.

Pancreatic enzymes are needed for the digestive system to break down fats, protein and carbohydrates so that they can be absorbed. When there is a deficiency of these enzymes, the body cannot absorb essential nutrients, and weight loss and malnourishment can result. Diarrhea can also occur. Synthetically manufactured digestive enzymes can be taken by mouth to replace lack of pancreatic enzyme production. Pancreatic enzyme deficiency can result from chronic inflammation, infection, tumor, or trauma to the pancreas.

Pancreatitis

Inflammation of the pancreas is termed pancreatitis. The major symptom of pancreatitis is severe pain, often accompanied by nausea, vomiting, and fever. Acute pancreatitis can be caused by a number of things. The two most common causes are heavy (or binge) alcohol consumption and gallstones. Other causes include drugs, trauma, high triglyceride levels, and hereditary conditions. Chronic pancreatitis can result from repeated episodes of acute pancreatitis, alcoholism, or certain other rare diseases. Acute pancreatitis may require hospitalization for treatment. It is diagnosed by examination of the abdomen, blood tests, ultrasound and x-rays. Most patients recover, but some patients, usually heavy alcohol users, may have a life-threatening illness. Long term complications such as chronic pain, diabetes and malabsorption may occur. Endoscopic exam with ERCP (see a separate pamphlet for explanation of this procedure) is often useful both for diagnostic and therapeutic purposes. In certain instances, surgery may be indicated.

Pancreas tumors

Tumors of the pancreas can develop. These may be either benign or malignant. Benign tumors can be relatively asymptomatic and require little treatment. Other benign tumors can secrete hormones, which can cause problems in various parts of the body. Malignant or cancerous tumors of the pancreas usually occur in middle-aged and older patients. At times they can cause blockage of the bile duct system and result in yellow jaundice. This is a serious illness that may be difficult treat. Endoscopically placed stents (with ERCP), and surgery may be helpful in relieving symptoms.

Gallstones

admin — Thu, 22 Dec 2011 21:38:57 +0000

Gallstones

What is the gallbladder?

The gallbladder is a small pear-shaped sack-like organ located beneath the liver in the right upper abdomen. Bile produced in the liver is carried by bile ducts to the gallbladder where the bile is stored. During a meal, the gallbladder contracts and pushes the bile into the small intestine where the bile serves mainly to digest fats. Fatty meals tend to cause the gallbladder to contract more vigorously and oftentimes cause more symptoms in patients with gallbladder disease. Gallstones are small hard collections of bile that can accumulate within the gallbladder.

What are the symptoms of gallstones?

Interestingly, most patients with gallstones never experience symptoms. Symptoms occur when gallstones either block the outlet of the gallbladder or bile ducts or when the stones irritate the gallbladder and cause gallbladder inflammation (cholecystitis). Stones that obstruct the outlet of the gallbladder (cystic duct) cause steady pain in the upper abdomen, usually on the right side under the ribs. The pain may radiate to the midback or under the right shoulder blade. Pain oftentimes occurs after eating when the gallbladder contracts and may last for several minutes up to several hours. Nausea or vomiting may also occur.

Stones that obstruct the bile ducts may cause pain, nausea, vomiting or jaundice. Stones that cause bile duct obstruction may also lead to bacterial infection in the bile ducts called bacterial cholangitis, which generally causes fever, chills and jaundice. Occasionally bacteria can spread to the blood stream (sepsis) and be life threatening. Gallstones can also block the opening of the pancreatic duct and cause inflammation of the pancreas (gallstone pancreatitis).

How do I know if I have gallstones?

An ultrasound of the abdomen is usually the initial diagnostic test in patients with a clinical history suggesting gallbladder disease. This test looks at the anatomy and structure of the gallbladder, liver and bile ducts. Stones within the gallbladder or thickening of the gallbladder wall may be seen in patients with symptomatic gallstones. Enlarged or dilated bile ducts can be seen by ultrasound in some patients with bile duct obstruction.

Some patients with symptoms suggestive of gallbladder disease may have a normal abdominal ultrasound. In these patients a study of gallbladder function called a hepatobiliary (HIDA) scan is often done. During this test a small amount of radioactive material is injected into the bloodstream through an intravenous catheter. The radioactive material circulates to the liver and concentrates in the gallbladder. An agent is then given through the IV that will cause the gallbladder to contract and empty. A diseased gallbladder usually does not contract and empty very well indicating a poorly functioning gallbladder. During this test patients with a diseased gallbladder oftentimes experience pain when the gallbladder is made to contract. ERCP (endoscopic retrograde cholangiopancreatography) can be helpful in detecting and removing stones from the bile ducts.

Treatment

Treatment of symptomatic gallbladder disease usually involves surgical removal of the gallbladder (cholecystectomy). Most patients undergo laparoscopic surgery in which three or four tiny incisions are made in the abdomen and small instruments are used to remove the gallbladder.

Rarely and only in special circumstances gallstone dissolving medication can be used to treat symptomatic gallstones. Most gallstones take one to two years to completely dissolve and often recur after medication is stopped.

Most patients function quite well without the gallbladder. The liver continues to produce and secrete bile into the small intestine allowing fat digestion and absorption to occur normally. Occasionally after cholecystectomy patients may experience diarrhea with meals. Postcholecystectomy diarrhea generally improves or resolves with time and is easily treated with dietary modification and occasionally medication.

Helicobacter Pylori

admin — Thu, 22 Dec 2011 21:35:35 +0000

Helicobacter Pylori

What is Helicobacter pylori?

Helicobacter pylori, commonly abbreviated H pylori, is a bacteria, which can cause infection of the lining of the stomach. It is a relatively new discovery first identified in 1982 by Australian researchers. It subsequently turns out that this is a relatively common bacteria, and may be the most common infection in the world. Only a small number of people who are infected by this bacteria experience any symptoms or problems from it. Infection is common in developing countries or areas where sanitation is poor. The rate of infection tends to increase with age. H pylori infects people after it is swallowed in food or fluids. Because the inside of the stomach is a very difficult place for bacteria to live due to the high acid content in the stomach, H pylori tends to be a very hardy organism.

Why is H pylori important?

As mentioned above, most people who are infected with H pylori remain asymptomatic. However, some conditions such as ulcers, some types of stomach cancer, and gastritis have been linked to H pylori. Gastritis is inflammation of the lining of the stomach that usually causes burning or pain in the upper abdomen. It is important to know that there are many other causes of gastritis besides H pylori. Ulcers occurring in the stomach or the duodenum (the first part of the small intestine) have a 60% likelihood of having an association with H pylori. In addition, there are usually other factors involved in ulcer disease, such as NSAID (anti-inflammatory) medication use and smoking.

Two types of cancer have been identified in which H pylori play a role. These are gastric cancer and gastric lymphoma. Determining whether or not H pylori is a causative factor is a complicated matter and requires diagnostic testing and consultation with a physician familiar with the bacteria. Diagnosis can be done with blood tests, breath tests measuring carbon dioxide, and biopsies from the lining of the stomach taken during endoscopy. Each test has unique pros and cons.

What is the treatment?

Since the infection is so common, in some cases no treatment is recommended. But in individuals with proven ulcer disease, symptoms due to gastritis, or gastric cancer or lymphoma, treatment may be necessary. As previously mentioned, H pylori is a hardy organism and can be somewhat difficult to eradicate. Effective treatment regimes include 2-3 different antibiotics and one antacid medication. It is not uncommon for treatment plans to require that a patient take eight pills per day for two weeks. Fortunately, most of these regimes are highly effective and side effects tend to be minimal.

Peptic Ulcer Disease

admin — Thu, 22 Dec 2011 21:34:55 +0000

Peptic Ulcer Disease

What is peptic ulcer disease?

Peptic ulcer disease is a common medical problem in the United States. Ulcers form in the lining of the esophagus, stomach and/or the small intestine.

What causes peptic ulcers to form?

The two most common causes of peptic ulcers are arthritis-type medications known as nonsteroidal anti-inflammatory drugs (NSAIDS) and a bacteria that can be present in the lining of the stomach known as Helicobacter pylori (H. pylori). Examples of medications that can cause ulcers include aspirin, ibuprofen, Motrin, Advil and Aleve. Some of these medications are also contained in over-the-counter remedies for colds or combination narcotic prescriptions. Therefore, it is important to review medication labels. Other factors that can contribute to ulcers are smoking, alcohol and spicy food intake.

What are the symptoms and possible complications of peptic ulcer disease?

Ulcers may cause a burning pain in the middle portion of the upper abdomen. This usually occurs about one hour or more after eating and can last from a few minutes to several hours. Less common symptoms of peptic ulcer disease are nausea, vomiting, decreased appetite, or becoming full quickly while eating. A serious complication of peptic ulcer disease is bleeding. Bleeding can cause vomiting of red blood clots or black material that resembles coffee grounds, or passage of black, tarry stools. Another complication is a perforation or hole in the stomach or small intestine. This would generally cause severe abdominal pain and a potentially life-threatening infection.

How is a peptic ulcer diagnosed?

A peptic ulcer may be suspected based on a patient’s symptoms and physical examination. Blood, breath and stool tests can be done to check for the Helicobacter pylori bacteria. If the test is positive, a patient may be treated with antibiotics to clear the infection. More direct studies to evaluate for a peptic ulcer are an upper GI endoscopy or upper GI x-ray (a patient drinks white, chalky liquid while x-ray pictures are taken). With an upper endoscopy, biopsies of the ulcer can be done. The tissue can be tested for H. pylori.

What is the treatment of peptic ulcer disease?

If Helicobacter pylori infection is diagnosed it can be treated with antibiotics for about 2 weeks. Treatment of ulcers related to arthritis-type medications includes stopping the offending medication if possible and starting medications that significantly decrease the acid levels in the stomach.

How can peptic ulcer disease be prevented?

Reducing or eliminating the use of nonsteroidal anti-inflammatory drugs is one way that peptic ulcers can be prevented. If a patient has to take one of these medications, the physician may advise the patient to stay on an acid-lowering medication to protect the stomach. The source of Helicobacter pylori infection is not certain but it appears to be spread from person to person. Adequate hygiene may be useful in preventing transmission of the bacteria.

Hiatal Hernia

admin — Thu, 22 Dec 2011 21:28:32 +0000

Hiatal Hernia

What is a hiatal hernia?

The stomach is normally positioned in the abdominal cavity below a large, thin, dome-shaped muscle, the diaphragm. The diaphragm separates the abdominal cavity from the chest cavity. The esophagus, in the chest cavity, passes through an opening or hole in the diaphragm called the hiatus where the esophagus joins the stomach. A hiatal hernia results when a portion of the stomach protrudes or herniates upwards through the hole (hiatus) in the diaphragm and into the chest cavity. Usually only a small portion of the stomach herniates up through the diaphragm. Occasionally the whole stomach can herniate through the diaphragm up into the chest cavity.

There are two main types of hiatal hernias, sliding and paraesophageal. A sliding hiatal hernia is the most common. In a sliding hiatal hernia, the junction between the esophagus and stomach as well as a portion of the stomach itself, protrude above the diaphragm. The herniated portion of the stomach may slide back and forth into and out of the chest cavity. In a paraesophageal hiatal hernia, the junction between the esophagus and stomach is in its normal place below the diaphragm but a portion of the stomach is pushed above the diaphragm and lies beside the esophagus.

Why do hiatal hernias occur?

Hiatal hernias are common, occurring in 60% of people by age 60. The cause is unknown and is thought to result from weakening and enlargement of the hiatus or hole in the diaphragm. Heredity may play a role in some, while in others obesity, straining or heavy lifting may cause the stomach to push up through the enlarged opening.

What are the symptoms of a hiatal hernia?

Most patients with a sliding hiatal hernia have no symptoms. Acid reflux is associated with a hiatal hernia and can cause heartburn or regurgitation. Excess belching or upper abdominal and lower chest pressure or pain can also occur. Prolonged and frequent reflux of acid into the esophagus may cause damage to the esophagus resulting in ulceration and bleeding. Scarring and narrowing of the esophagus can also occur with chronic reflux and cause difficult or painful swallowing. Other symptoms of gastroesophageal reflux can include sore throat, hoarseness, excess salivation, the sensation of a lump in the throat (globus), sinusitis, frequent throat clearing, cough, wheezing or asthma. Chronic reflux can also lead to a condition called Barrett’s esophagus, which can lead to the development of esophageal cancer.

A paraesophageal hernia is not as common as the sliding hiatal hernia. Paraesophageal hernias can sometimes get trapped or squeezed by the diaphragm and lose blood supply. This condition, called strangulation, is a serious and often painful condition that requires immediate surgery.

How do I know if I have a hiatal hernia?

Hiatal hernias are diagnosed by either upper GI x-ray or by endoscopy. Treatment of symptomatic hiatal hernias involves treating gastroesophageal reflux with dietary modifications and medications. The majority of patients do well with medical treatment.

More patients are now being referred for surgical repair of hiatal hernias, particularly younger patients who may require life-long medical treatment, or patients who do not respond to medical treatment. The procedure is called laparoscopic fundoplication and involves wrapping the upper part of the stomach, called the fundus, around the lower part of the esophagus. The wrapped fundus is sutured together around the esophagus (fundoplication).

Gastroesophageal Reflux Disease (GERD)

admin — Thu, 22 Dec 2011 21:27:35 +0000

Gastroesophageal Reflux Disease (GERD)

What is GERD?

Gastroesophageal reflux disease (GERD) is a disease where the contents of the stomach move upwards into the esophagus. At times this phenomenon happens in everyone and is considered normal. When it happens frequently or causes symptoms, it is considered abnormal and is referred to as GERD.

Why does reflux happen?

The connection between the esophagus and stomach is a round muscular band known as the lower esophageal sphincter. This sphincter is designed to hold pressure at the esophagus and stomach connection and prevent reflux of stomach materials, namely acid. For a variety of reasons, the sphincter can become “lazy” and allow frequent stomach content reflux. “Laziness” can occur due to medications, age, smoking, and hiatal hernia.

What are the symptoms of GERD?

Symptoms of GERD are most commonly heartburn and regurgitation. Heartburn is different for each person, but commonly described as a burning or painful feeling in the low chest. Regurgitation usually refers to the sensation of food or fluid moving up into the chest or even back of the throat. Other symptoms associated with GERD include difficulty swallowing, sore throat, hoarse voice, chest pain, chronic chough or choking, and frequent sinus or ear infections.

How do I know if I have GERD?

Your physician generally makes the diagnosis of GERD based on your symptoms. Other examinations that aid in the diagnosis of difficult or complicated cases include upper GI endoscopy, 24-hour pH monitoring (this involves a tube into your esophagus via your nose that measures reflux of acid into the esophagus), barium swallow tests/upper GI series, and esophageal manometry (another tube into the esophagus via the nose that measures esophageal squeezes).

What is the treatment?

There are a variety of medications that can be used to manage GERD symptoms. Simple therapies such as TUMS, Rolaids or Mylanta can be very helpful. Over-the-counter medications that help decrease acid include ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) or omeprazole (Prilosec OTC). The strongest drugs available for acid suppression must be prescribed by your doctor and include Prevacid, Nexium, Protonix, and Aciphex. This class of medication acts to block acid secretion within the stomach. These have been extremely successful medications and are very well tolerated.

Other novel approaches to treatment of GERD exist. Surgical antireflux procedures are successful and well tolerated. Your physician can help you to decide if you are a good candidate for such an intervention.

Complications of GERD

Unfortunately, complications of acid reflux do sometimes occur. One of the most common problems associated with GERD is narrowing of the lower esophagus, called a stricture or ring. Strictures can form in patients both with and without regular symptoms of GERD! Strictures cause difficulty with swallowing and often must be stretched via upper GI endoscopy. Barrett’s esophagus is another complication, defined as an alteration of the tissue lining of the lower esophagus due to chronic acid damage. Barrett’s is a pre-cancerous condition diagnosed by upper GI endoscopy and needs to be watched regularly by your Gastroenterologist. Some lung issues such as asthma and pneumonias can be associated with frequent regurgitation of stomach contents into the mouth and ultimately lungs.

Hemochromatosis

admin — Thu, 22 Dec 2011 21:26:40 +0000

Hemochromatosis

What is hemochromatosis?

Hemochromatosis is a disease characterized by iron overload. It affects many organs in the body including the liver, heart, pancreas, joints and skin. Iron is normally absorbed in the small intestine in proper amounts necessary for the body’s function. In patients with hemochromatosis, a genetic mutation affecting the small intestinal cells allows for excess absorption of iron. The excessive amount of iron eventually gets deposited in organs like the liver, where it causes damage. Hemochromatosis is one of the most common inherited diseases, affecting one out of every 300-400 people. The disease is often silent until irreparable damage has been done.

Genetics

The gene is present in one out of every ten people. Not all people who have the gene will get the disease. One must inherit two abnormal gene copies, one from each parent, to get hemochromatosis. Due to the common nature of the abnormal gene, it is important that family members of patients with hemochromatosis be tested.

What are the symptoms of hemochromatosis?

Symptoms are often not detectable until damage to organs has been done. Most patients are between the ages of 40 and 60 when the diagnosis is made. Women can be older at diagnosis due to menstruation throughout their lives. The specific symptoms are based on the damaged organ – in the case of liver disease symptoms can include weakness, jaundice, easy bleeding, swelling of the legs or abdomen, or abdominal pain. Iron damage to other organs can cause congestive heart failure, diabetes, and arthritis.

How is a diagnosis made?

Early diagnosis is important to prevent further organ damage due to excess iron. When a family history of hemochromatosis exists, family members should be screened. The diagnosis of hemochromatosis can be suggested by laboratory tests such as iron levels and liver enzymes. Liver biopsy usually confirms the diagnosis. A genetic test to look for the most common genetic mutations associated with the disease is available and can be ordered by your physician.

What is the treatment?

Red blood cells are one of the richest sources of iron in the human body. In patients with hemochromatosis, blood is usually removed from the patient to lower the number of red blood cells, and thus lower the overall levels of iron. It may take multiple sessions of blood removal over several months to accomplish the proper iron levels. If excessive liver damage has occurred and caused cirrhosis, liver transplantation can be performed with great success. Alcohol seems to make progression of any liver disease faster in patients with hemochromatosis, thus it should be avoided. Iron supplements should be avoided, as should vitamin C supplements, since vitamin C helps to increase bowel absorption of iron. Consumption of iron rich foods like red meat are not prohibited, but excessive consumption should be avoided.

Autoimmune Hepatitis

admin — Thu, 22 Dec 2011 21:26:00 +0000

Autoimmune Hepatitis

The liver is a large organ located in the right upper abdomen behind the rib cage. There are a variety of problems that can affect the liver such as viruses, alcohol, fat, medications, genetic disorders, and autoimmune diseases. Some of these may cause irritation or inflammation of the liver. Inflammation of the liver from any cause is called hepatitis.

What is autoimmune hepatitis?

The immune system consists of a variety of white blood cells that can help fight against infections including bacteria and viruses, foreign cells, or organs such as with transplants. Sometimes the immune system can be triggered to attack tissues in our own body. This is known as an autoimmune disease. In the case of autoimmune hepatitis the immune system mistakenly attacks cells in the liver. The factors that trigger the immune system to do this are unknown. Autoimmune hepatitis occurs mostly in women (70 %).

What are the symptoms of autoimmune hepatitis?

Symptoms of autoimmune hepatitis can include tiredness, muscle and joint aches, decreased appetite, nausea, vomiting, and right upper abdominal pain. If there is more serious liver injury patients may notice yellowing of the eyes and skin called jaundice, itching, abdominal swelling or confusion.

How is autoimmune hepatitis diagnosed?

Liver blood tests are the initial tests that can indicate there is a liver problem. More specific blood tests looking for antibodies to one’s own tissues can be done. Examples of blood tests that are done when autoimmune hepatitis is suspected include anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA) and anti-liver/kidney microsome (anti-LKM). A liver biopsy can also be helpful to diagnose autoimmune hepatitis and also to determine if there is any damage to the liver.

How is autoimmune hepatitis treated?

The treatment of autoimmune hepatitis consists of medications that decrease the activity of the immune system. Prednisone is commonly used in the treatment of autoimmune hepatitis. Another medicine called azathioprine (Imuran) is sometimes added to the treatment to further decrease the inflammation of the liver. These medicines can improve both symptoms and the liver blood tests. Prednisone has a number of potential side effects including insomnia, weight gain, diabetes, hypertension, and osteoporosis. The addition of azathioprine can help reduce the dose of prednisone. Azathioprine can cause a decrease in the blood cells (such as white blood cells) made by the bone marrow. Frequent blood testing (approximately monthly) is done to follow the blood counts closely. The lowest dose of medicines is used to try and lessen these potential side effects.

Patients with autoimmune hepatitis need to be monitored closely. As the symptoms and blood tests improve, the dosage of the medications can be slowly decreased. If the medications are discontinued some patients have a relapse of autoimmune hepatitis and may need to stay on medicines long-term to decrease the immune system. Autoimmune hepatitis can cause permanent scarring of the liver also known as cirrhosis. If a patient with cirrhosis shows signs of liver failure then liver transplantation may need to be considered.

Fatty Liver Disease

admin — Thu, 22 Dec 2011 21:24:22 +0000

Fatty Liver Disease

What is fatty liver disease?

Fatty liver disease is when fat accumulates in the liver. Fat is commonly found in the liver and does not necessarily cause abnormalities or disease. In some individuals, however, the fat present can stimulate inflammation or even scarring in the liver. Fat can be deposited in the liver for many reasons, including alcohol abuse or even viral hepatitis.

Definitions

Fatty liver disease is the presence of fat in the liver without the coexistence of damage. When fat leads to inflammation, the process is called steatohepatitis . When the nidus for liver inflammation is something other than alcohol, the process is referred to as nonalcoholic steatohepatitis (NASH). When inflammation becomes severe, scarring of the liver ensues, and this is known as cirrhosis.

Symptoms and diagnosis

Fat in the liver is most commonly asymptomatic. If the liver swells in response to the fat, right upper abdominal pain or shoulder pain can develop. Fatigue can also be present. Most commonly, mild abnormalities in blood liver tests will be found. Fat may be seen on ultrasound, CT scanning and can be quantitated by liver biopsy. Your physician will likely eliminate other causes of liver disease before settling on a diagnosis of fatty liver disease.

What are the causes of fatty liver disease?

There are many causes of fatty liver and steatohepatitis. The most common of these include alcohol, obesity, hepatitis C, diabetes, high cholesterol or triglycerides, and certain medications, such as corticosteroids.

What is the treatment?

The treatment of fatty liver is related to the cause. It is important to remember that simple fatty liver does not require treatment, since it does not result in damage to liver cells. Obese patients with fatty liver will have reduction or loss of excess fat in liver cells if substantial weight loss can be achieved. It is very important that weight loss be slow and controlled, however. In alcoholic fatty liver, discontinuation or a decrease in alcohol consumption are required. Good control of diabetes mellitus with diet, medication, or insulin also decreases the fat content in the liver.

To date, there are no proven medications to improve or cure steatohepatitis. Preliminary data and anecdotal data suggest vitamin E and vitamin C may be helpful. Your doctor may also suggest ursodeoxycholic acid or milk thistle. There is hope that some anti-diabetic medications may be helpful for the disease, but research is still ongoing.

Hepatitis C

admin — Thu, 22 Dec 2011 21:19:31 +0000

Hepatitis C

What is hepatitis C?

Hepatitis is the term used to describe inflammation within the liver. There are many causes of hepatitis such as alcohol, medications, drugs, hereditary diseases, and other viruses. Hepatitis C is a virus, which affects many parts of the body, but the liver is the area that can be most seriously damaged. Hepatitis C can be acute, meaning the patient is infected and becomes ill, then completely recovers from the infection. Most cases, however, are chronic. The patient may not even know they have become infected with hepatitis C. They harbor the hepatitis C virus in their system long after initial infection and damage can be done over many years. It is estimated that about 4 million Americans are infected with the hepatitis C virus.

How do I get hepatitis C?

Hepatitis C is transmitted through blood products. The most common means of becoming infected include sharing needles for intravenous drug use or tattoo placement, nasal cocaine use, or blood transfusions prior to 1992. Prior to that year, testing of our blood supply was not accurate, and some hepatitis C was spread. We now have excellent testing to detect hepatitis C in the blood, although a very small risk of hepatitis C transmission still exists with certain diseases requiring repeated blood transfusions. Health care workers are also at risk of acquiring hepatitis C through accidental blood and needle exposure. Risk of transmission through sexual contact is controversial; although a slight risk exists, it is heightened in the setting of coexistent sexually transmitted diseases and having multiple sexual partners. The best protection from any sexually transmitted disease is barrier contraception. Patients in long-term monogamous sexual relationships are generally considered safe for unprotected sex. Spread of hepatitis C from mother to fetus is extremely low. Women wishing to become pregnant should speak with their physician. Hepatitis C cannot be passed between family members by casual contact like hugging or kissing. The smartest way to prevent transmission is to use common sense regarding any items in the home that may be exposed to the infected person’s blood – avoid sharing razors, toothbrushes, and manicure items.

Symptoms and Diagnosis

The vast majority of patients with hepatitis C have no idea they are infected. Only rarely does the initial infection cause jaundice, nausea, fatigue, diarrhea and generalized illness, which are the hallmark symptoms of acute infection with hepatitis A and hepatitis B. Blood testing must be performed to look for the presence of hepatitis C. Approximately 75 percent of patients exposed to hepatitis C will develop chronic infection.

Course of Disease

Cirrhosis, or scarring of the liver, is the dreaded complication of chronic hepatitis C infection. It is estimated that only 25 percent of those with chronic hepatitis C will develop advanced cirrhosis within their natural course of life. Unfortunately, predicting which patients fall into that 25 percent group is impossible. Thus therapy is considered for all who are infected. Alcohol will speed up development of cirrhosis significantly, so avoidance of alcohol is imperative for patients infected with hepatitis C.

What is the treatment?

There is no vaccine to prevent hepatitis C. Once infection has occurred, treatment is a complicated topic that your physician will approach very thoughtfully. Many tests may need to be performed prior to considering therapy, such as laboratory testing, CT or ultrasound of the liver, and liver biopsy. The medication is twofold: ribavirin is an oral medication taken daily, and peg-interferon is an intramuscular shot given once a week by the patient. These medications can be dangerous if not used properly, so routine lab work is necessary during the course of therapy. It is very important that you and your physician are in close contact, and the patient is compliant with lab testing and office visits as requested by their doctor. Alcohol should be strictly avoided during therapy. Therapy is given from 12-48 weeks, depending on which subtype of virus the patient has (called the genotype), the patient’s response to therapy, and side effects, which can include many problems from lab abnormalities to depression. Anywhere from 40-80 percent of patients are cured of hepatitis C with therapy. The goal of hepatitis C therapy is to prevent cirrhosis. In some instances, hepatitis C causes advanced cirrhosis, requiring liver transplantation.