Chronic active hepatitis: the challenge for a new nomenclature.

OBJECTIVES: To review the etiologic agents and pathogenic mechanisms of chronic active hepatitis, to describe the current nomenclature for this disease and highlight its shortcomings, and to propose guidelines for change. DATA SOURCES: Relevant references were identified through a MEDLINE search (1982 to 1992), through prominent review articles and texts, and through a personal library of journals and reprints. Additional references were selected from the bibliographies of identified articles. STUDY SELECTION: All pertinent articles on the etiologic agents, pathogenic mechanisms, and nomenclature of chronic active hepatitis were studied. DATA SYNTHESIS: Subtypes of chronic active hepatitis can be defined by etiologic agent or immunoserologic marker, and these subtypes may have different clinical features, prognoses, pathogenic mechanisms, and treatments. An unauthorized jargon has evolved to accommodate these subtypes, and it may wrongly or prematurely connote their validity. Patients with cryptogenic disease, mixed viral and immunologic features, and atypical findings lack a formal designation. No established mechanism exists for modification of the nomenclature.
CONCLUSIONS: Chronic hepatitis can be subclassified into different subtypes that are defined by etiologic agent or by predominate pathogenic mechanism. A new nomenclature must be based on this knowledge. Formal mechanisms must be established to revise the nomenclature and to promulgate change.