Ann Intern Med 1993 Sep 15;119(6):510-7

Chronic active hepatitis: the challenge for a new nomenclature

Czaja AJ
Mayo Clinic, Rochester, Minnesota.

Abstract
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