Clinical spectrum of acute sporadic hepatitis E and possible benefit of glycyrrhizin therapy.

The aim of the present study was to record the spectrum of sporadic hepatitis due to hepatitis E virus infection with special reference to moderate and severe liver disease, described as sub-acute hepatitis. Further, efficacy of glycyrrhizin therapy was studied as an open trial. Sixty-two consecutive patients were registered for the study. The clinical and laboratory profile of the patients was recorded on a preplanned proforma. Moderate and severe hepatitis was arbitrarily defined on the basis of clinical symptoms and serum bilirubin (total) of 10-15 mg% and 16 mg% or higher, respectively, at the time of presentation. It was noted that 22 (36.1%) of acute sporadic hepatitis E patients had moderate or severe liver disease. Glycyrrhizin was administered to these 22 patients by intravenous (IV) route in the dose of 60 ml daily. Therapy was tapered and stopped once significant clinical and biochemical improvement was noted. All patients showed clinical improvement by the seventh day of therapy. Total bilirubin was reduced by 68.9% by the end of 2 weeks of treatment and at this time, reduction in AST and ALT levels was to the tune of 94 and 97%, respectively. Normalization of AST and ALT levels was recorded in 19 patients (86.4%) and total bilirubin in 13 (59.1%) patients within 30 days of commencement of therapy. There were no side effects of IV glycyrrhizin therapy. It is concluded from the results of the present study that over one-third patients with acute sporadic hepatitis E in India have either moderate or severe liver injury. IV glycerrhizin therapy in this group of patients is well tolerated and effective.