Hepatitis refers to inflammation of the liver that is often caused by a viral infection. There are 5 main hepatitis viruses – A, B, C, D, and E. All these hepatitis viruses can initially cause similar symptoms like fatigue, nausea, fever, and jaundice. However, diarrhea is not a commonly associated symptom with most forms of viral hepatitis.
In some cases though, hepatitis may indirectly lead to diarrhea due to various mechanisms. This article explores the links between different types of hepatitis and diarrhea along with management strategies.
Types Of Hepatitis Causing Diarrhea
▪️ Hepatitis A
Hepatitis A virus is one of the most common causes of infectious hepatitis transmitted through contaminated food or water. In adults with hepatitis A, diarrhea occurs in 20-50% of patients several days or weeks before the onset of jaundice and peak liver enzyme elevations. The diarrhea is caused by the direct invasion of the hepatitis A virus into the gastrointestinal mucosa.
▪️ Hepatitis E
Like the hepatitis A virus, hepatitis E is also transmitted through fecal contamination of food and water supplies. Diarrhea can occur in 30-70% of acute hepatitis E cases.
Hepatitis E infection is common in developing regions with poor sanitation. Pregnant women are especially at high risk of severe hepatitis E with potentially fatal outcomes.
▪️ Drug-Induced Hepatitis
Several drugs used to treat other medical conditions can occasionally cause drug-induced hepatitis as a side effect.
Medications that are associated with drug-induced hepatitis include certain antibiotics, anti-seizure drugs, rheumatologic agents, and more. Drug-induced hepatitis can manifest with diarrhea along with nausea, jaundice, and fever resembling viral hepatitis.
▪️ Alcoholic Hepatitis
Excessive alcohol consumption over many years can lead to alcoholic liver disease. The acute form is termed alcoholic hepatitis.
Diarrhea affecting up to 50% of patients may occur in alcoholic hepatitis. This is not directly due to alcohol, but secondary to impaired liver function and portal hypertension altering intestinal absorption and permeability.
Causes Of Diarrhea In Hepatitis
The mechanisms by which hepatitis can induce diarrhea include:
- Direct viral invasion of gut mucosa by hepatitis viruses A and E
- Drug-induced damage to liver cells altering digestion and absorption
- Bile acid malabsorption from liver dysfunction and inability to reabsorb bile salts
- Portal hypertension and edema causing fluid leakage into intestines
- Alterations in gut microbiome composition
- Bowel ischemia from low blood flow states in advanced cirrhosis
Treatment And Management Of Hepatitis Related Diarrhea
- Oral rehydration solutions – Important to prevent dehydration from fluid loss
- Symptom relievers like loperamide or diphenoxylate may alleviate diarrhea by slowing gut motility
- Treat underlying hepatitis – Specific antivirals for hepatitis B, supportive care for alcohol-related hepatitis
- Low-fat diet – Reduces fat malabsorption and stool volume in cholestatic hepatitis
- Bile acid sequestrants like cholestyramine – Bind bile acids; which useful in bile acid diarrhea
- Probiotics – May help restore a healthy gut microbiome
- Ascorbic acid – Improves bile solubility and absorption in cholestatic hepatitis
- Avoid aggravating drugs like antibiotics, magnesium, and lactulose, which can worsen diarrhea
Precautions and Preventive Strategies
- Maintain hydration and electrolyte balance
- Follow food safety practices like hand hygiene, proper cooking temperatures, and storage
- Avoid contaminated water sources
- Vaccination for hepatitis A and B to prevent infection
- Practice safe sex and avoid injection drug use
- Limit alcohol intake
- Screen for hepatitis and monitor liver function with bloodwork
Conclusion
In summary, while diarrhea is not a predominant feature in most types of viral hepatitis, it can be seen in hepatitis A, E, and drug-induced hepatitis. The pathophysiological mechanisms include direct infection of the gut epithelium, alterations in bile acid metabolism and absorption, and microbial imbalance.
Management involves hydration, diet modification, symptomatic relief, treating the underlying liver condition, and correcting bile acid imbalance. With a proper understanding of the link between hepatitis and diarrhea, effective treatment strategies can be devised to provide symptomatic relief and treat the hepatitis infection.
Preventive approaches like vaccination, hygiene, safe sexual practices, and judicious use of medications can also help reduce the risk of developing hepatitis with diarrhea as a secondary manifestation.
