Chronic active hepatitis. Aetiological considerations based on clinical and serological studies.

The diagnosis of chronic active (aggressive) hepatitis is based mainly on characteristic morphological changes. During a 7-year period, 85 cases were diagnosed in three medical departments in Copenhagen. This material is presented by clinical, biochemical, and serological variables at the time of diagnosis. None of the patients had simultaneously occurring Australia antigen and circulating autoantibodies. A comparison between two serologically homogeneous groups revealed significant differences in sex and age distribution onset of disease, and biochemical activity. The investigation suggests the existence of aetiologically different forms of chronic active hepatitis. Some cases are apparently caused by a persistent viral infection, while others may be due to a primary autoimmune mechanism. A considerable number of the patients stated that they had had prolonged intake of the potentially hepatotoxic laxative, oxyphenisatin. Nineteen patients were challenged with the drug and eight reacted with an increased biochemical activity in the liver disease. All these patients belonged to the group with circulating autoantibodies. It is possible that oxyphenisatin may be the primary cause of the chronic liver damage in some cases.