[Cholestatic-type hepatitis in childhood]

Abstract

Objective: The aim of this study was to evaluate the incidence, etiology, clinical evolution and prognosis of cholestatic hepatitis during childhood.

Patients and methods: A retrospective study of 145 children hospitalized for acute hepatitis between December 1983 and September 1996 were studied. Cholestatic hepatitis was defined by a direct bilirubin higher than 50% of the total bilirubin.

Results: Five cases were identified, which represents 3.45% of all hospitalized hepatitis cases. The average age was 8 years. Cholestatic symptomatology was predominant in all cases with bilirubin values ranging from 10.5 to 32 mg/dl. Cytolysis ranged from moderate to intense. Regarding enzymes indicating cholestasis, the most elevated was 5'nucleotidase, followed by GGT. Quick's index was abnormal in 2 cases, one of which was not corrected by vitamin K. Cholesterol, triglycerides and gamma globulins were slightly increased. In only one case was there a thickening of the wall of the vesicula, which was dilated. Three cases corresponded to hepatitis A virus, one to hepatitis B virus and SMA (smooth muscle autoantibodies) were identified in the fifth. Evolution was favorable in all patients within 8 weeks, except for a girl with subacute hepatocellular insufficiency (SMA positive) where a normal state was achieved 3 months after immunosuppression treatment was started.

Conclusions: 1) Cholestatic hepatitis is an infrequent form of acute hepatitis evolution in childhood and can be promoted by hepatitis virus A or B. 2) It shows a favorable prognosis, except when it comes from a non-viral etiology.