CHRONIC HEPATITIS - WHAT IS ACTIVITY AND HOW SHOULD IT BE ASSESSED

Hepatitis means more than inflammation of the liver; it includes an essential element of hepatocellular damage, itself probably mediated by the infiltrating lymphocytes(1). Correspondingly, the concept of activity takes into account both inflammatory infiltration and hepatocellular damage. Histological activity is important for the patient and the clinician because it provides a measure of severity of the hepatitis at the time of biopsy not always matched by abnormal liver function tests(2). The idea that it might also influence prognosis led to the 1968 classification of chronic hepatitis into chronic persistent and chronic active forms(3), with the subsequent addition of chronic lobular hepatitis(4). The reasons have been discussed elsewhere(5-10); briefly the principal reasons are the greatly increased knowledge of the hepatitis viruses, the observation that patients with chronic hepatitis C and predominantly portal inflammation may nevertheless develop cirrhosis, and the omission of forms of liver damage other than piecemeal necrosis from the 1968 classification.

Author: SCHEUER PJ, ROYAL FREE HOSP, DEPT HISTOPATHOL, POND ST, LONDON NW3 2QG, ENGLAND
Source: HISTOPATHOLOGY 1997 FEB;30(2):103-105

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