Hepatitis refers to an inflammatory condition of the liver. It is commonly caused by a viral infection. But there are other possible causes of hepatitis too. Medicircle is conducting a Hepatitis Awareness Series on the occasion of Hepatitis Awareness Month to raise awareness on the importance of testing for hepatitis, the availability of effective care and curative treatment, and the serious health consequences resulting from undiagnosed and untreated viral hepatitis.

Dr. Tom Cherian is the Founder and Managing Director of South Asian Liver Institute, Hyderabad which is an organization dedicated to the study of liver and treatment of liver ailments. He is Group Director, Liver Surgery and Transplantation, CARE Hospitals Group and Professor (GI Surgery) at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad. He has a rich experience of over 25 years in HPB and liver transplant surgery. Out of this, 14 years have been spent in the UK. He has performed over 650 liver transplants including those of children. He is a Liver Specialist with expertise in complex (Split, Domino, Auxiliary) Liver Transplants & has even innovated pediatric transplant techniques. He has 84 published papers/abstracts and 100 international presentations to his credit. Dr. Tom is a passionate surgeon with an ambition to bring world-class treatment to the common man in the field of liver diseases. 

If you are eating contaminated food, you can get infected from Hepatitis A or E

Dr. Tom explains, “Many viruses affect the liver, more than other organs. Those viruses are a group called hepatitis viruses. The common five are hepatitis A, B, C, D, and E. There is hepatitis G as well. Out of these, what affects humankind is A, B, C, and E. Hepatitis A and E viruses are transmitted in the fecal-oral route that means from contaminated food, contacts, etc. Your local panipuri wala can transmit hepatitis A and E, and these are the commonest viruses. The good news about these two is that they are self-limiting conditions, which don't cause any long-term sequelae. They cause jaundice for about 10 to 14 days, and the vast majority get better. Hepatitis A and E can cause acute liver failure where death is possible. But that is quite rare.” 

Hepatitis B is a severe virus but fortunately, we have vaccine as well as fantastic treatment options now

Dr. Tom mentions, “Hepatitis B is a very clever virus. It integrates itself into the genome of all our cells, which makes it almost impossible to cure. But the good news is, that for the last 10 to 12 years, we have had fantastic treatment options, which allows us to give a single tablet a day, and that keeps the cell count or the viral count low, therefore limiting the damage it can cause on the liver. We have very effective vaccines for hepatitis B. It’s part of the universal vaccination program which the Government of India started in 2008 or 2009. 

We ran a program at South Asian liver Institute via foundation to run vaccination campaigns for children born before 2007, who are still in school, because they sort of fell through the gap because the government program started after they were born. So, all of us, whether we have had hepatitis in the past or not, should take the vaccine for hepatitis B if we haven't. It has almost no side effects. It's just three jabs. It is not expensive. Occasionally, you might need a booster.”

Until about three or four years ago, hepatitis C was the deadliest of all Hepatitis viruses

Dr. Tom points out, “3-4 years back, hepatitis C was the deadliest virus. This is because it could cause the maximum damage in terms of the percentage, so a large number of people who got hepatitis C developed cirrhosis. But during that phase, we only had one treatment, which is pegylated interferon, which was effective only in about 40 to 50% of people and had multiple side effects. So, you can imagine that combination of poor outcomes and high complication rates meant it wasn't a very ideal treatment. So, hepatitis C would have been to many, a death sentence, if not immediately, then slowly, because of the onset of liver failure, and liver cancer. Of course, liver transplantation was the only solution for many of these people. If we look at the last three to four years, the statistics are changing now, approximately 30 to 35% of transplants worldwide were for viral hepatitis.” 

Many people can recover from Hepatitis A even without treatment

Dr. Tom says, “One can recover from hepatitis A in 10 days to 2 weeks. In the first few days, one does not even know that he / she has been suffering from hepatitis A. Slowly jaundice starts and that is when people realize that something is not right. One starts feeling tired, and roughly a week to 10 days afterward, it gets better. Many people try ayurvedic treatment for this but the vast majority of them would have gotten better even without treatment,” says he.

No direct connection between Diabetes and Hepatitis

Dr. Tom points out, “Diabetes is a global disease. It affects immunity too. Because of its global effect if a diabetic person gets hepatitis, then he or she might be more likely to have the complications of the disease, for example, diabetes can cause fatty liver. Fatty liver complications might aggravate if you get Hepatitis B or A. The effects are going to be a little bit more profound, and you're going to be a little sicker and the chances of a complete liver failure are slightly higher because you are already dealing with the injured liver. So, this is the connection that I can see between diabetes and hepatitis, and other than that there is no direct connection between diabetes and hepatitis,” mentions Dr. Tom.

Covid does not directly affect the liver

Dr. Tom says, “Covid directly does not affect the liver. But because it affects the lungs, oxygenation can come down. When oxygenation comes down, other organs are damaged that might include the liver, so that is one way in which these two things can be related but there is no direct effect as such”

South Asian Liver Institute’s Initiative for Liver patients in Covid crisis

Dr. Tom informs, “Liver patients are unfortunately having illnesses, some of them are quite sick, but they are a little bit scared to come to the hospital. They are sometimes not able to reach the doctor because the doctors are very busy. They are not able to get beds when normally they would be treated in the hospital. So, for this group of people, the South Asian Liver Institute has started a new service. It is meant to help patients with liver disease during the Covid crisis.”

He further mentions, “Many liver patients are already what we call auto anticoagulants. That means that clotting is already abnormal, because of the liver function. And those are the people who should not be taking those antiplatelet drugs that all the pharmacies seem to be handing out nowadays because it is possible that the clotting will worsen even further to a dangerous level. 

So, a few tweaks, a few changes here and there to the treatment is required. Nothing too dramatic needs to be done differently, maybe a little bit more precaution towards being well hydrated. Otherwise, it is just supportive treatment. If your oxygen levels are not falling, if you're not feeling short of breath, I think the safest is to stay at home. Take a healthy diet, cut down on a high sugar diet because high sugars are bad for us at all times. And it does become even worse during illnesses and therefore a very balanced diet, a diet that is rich in antioxidants like a lot of leafy green vegetables, little fruits will be a step forward. 

Hopefully, other organizations too would come up with such facilities for liver patients like the one being offered by the South Asian Liver Institute,” adds Dr. Tom.

Advice for liver cancer patients in these Covid times

Dr. Tom says, “I get calls from patients with liver disease and sometimes liver cancers. At the moment, my advice is most cancers, even liver cancers even though they are fast-growing compared to some others, is that if we can wait a little while until at least the peak is over, then maybe we can create non-Covid areas in our hospitals. Then we could try and bring such patients in for urgent surgery.  In these few weeks, it is unlikely that it progresses too much. However, there is a small possibility. For example, if you have liver cancer that is very close to becoming inoperable. They may not be able to wait even two months or three months and then there may be an argument for trying to get them into a smaller hospital that doesn't have that many covid patients and trying to quietly do the operation without much exposure. But I think those sorts of questions should be addressed once we have a better understanding of the state of the disease and accordingly decide further course of action for each patient - whether to immediately start further treatment or upgrade the current treatment after this peak time is over,” suggests Dr. Tom.

(Edited by Amrita Priya)