Home' Trinidad and Tobago Guardian : July 14th 2017 Contents A26 body & soul
guardian.co.tt Friday, July 14, 2017
World Hepatitis Day takes place annually on
July 28 and aims to raise global awareness of
viral hepatitis and to influence change. As we
approach WHD 2017, writer Christine Dalkan
asks Dr Rene Ramnarace, a consultant gastroen-
terologist, to shed some light on hepatitis. Here
is the conclusion of that interview.
Can it be treated?
Presently, if the cause of the jaundice is identified
early, it can be treated---accepting that in some cases
the treatment is simply a lifestyle adjustment. There-
fore, if alcohol is the underlying cause, stopping alcohol
would be the best intervention.
With regard to the viral hepatitis: Hepatitis A usually
goes away on it own. We can vaccinate against Hep
A for short-term protection, especially when trav-
elling to exotic destinations. Hepatitis B may clear
spontaneously. If it does not, there are medications to
suppress the virus and improve the liver dysfunction,
but we have not found a cure for hepatitis B just yet.
Hepatitis C is now, for the most part, curable with
the advent of new agents in the last five years. The other
rarer causes can be either controlled or managed with
appropriate intervention, if identified early enough.
What are the treatment options available locally?
We are fortunate in Trinidad that all of the medica-
tions needed to treat the acute hepatitis are available
or accessible. The problem in treatment arises when
the warning signs are ignored and there is irreversible
damage to the liver---cirrhosis. We do not have access
to adult liver transplantation locally.
How can hepatitis be prevented?
For the viral hepatitis A and Hepatitis B, the answer
is vaccination. Take care when consuming shellfish
to prevent Hepatitis A. Hepatitis B and C are derived
from blood and body fluids. We are not a community
that abuse intravenous drugs, and despite the quoted
statistic that we have a high incidence of hepatitis C,
this is not reflected in our current practice.
The issues of weight reduction, control of diabetes
and high triglycerides and cholesterol are important
for non-alcoholic steatohepatitis. If we accept this is
going to be the leading cause of cirrhosis in the next
ten-20 years, a positive lifestyle change is needed.
Every year, alcohol-related liver cirrhosis results in
the death of many citizens across all socio-economic
groups. Accepting that stopping alcohol is difficult
for some, then identifying those at risk would be the
best way to assist them and help: through the medi-
cal practitioners, gastroenterologists, psychiatrists,
psychologists, counsellors, religious and community
leaders and/or the support of entities like alcoholic
anonymous, some guidance and input can be initiated
to prevent a poor outcome in the future.
Since hepatitis affects the liver, can you explain
the importance of the liver in the human body?
We only have the solitar, one liver. There is no back-
up. The liver is a storage organ, a filter for toxins, and
a factory for protein and clotting factors.
All the blood that leaves the gut via the liver is usu-
ally filtered there---toxins and infectious agents are
removed, nutrients needed for health are extracted,
and unwanted materials are detoxified and excreted.
Many medications pass via the liver to become
metabolically active. The liver is also responsible for
removing medications from the circulation. Therefore
without a functional liver, life is not sustainable in
the short to medium term. With an acute injury to
the liver, there is the ability for repair, but if this is
overwhelmed, then irreversible injury occurs.
Can hepatitis worsen diabetes?
Not usually, unless steroids are being used for treat-
ing very specific causes of hepatitis.
What are the tests to do to find out whether
you have hepatitis, and what type it might be?
Ideally, if one is concerned about their liver either
due to family history or lifestyle, then a GP should
be the first port of call. Some simple blood tests can
identify if the liver is injured or not. If the results are
abnormal, usually an ultrasound scan, and discussion
and referral to a gastroenterologist, would be the next
Can hepatitis be cured?
As we understand the viral entities further, I think
the honest answer is yes.
World Hepatitis Day: July 28
Hepatitis can be treated
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