Versicherungsmedizinische Risikobeurteilung von pathologischen Leberwerten und aktuellen Entwicklungen bei der chronischen Hepatitis

Alcoholic liver disease, non alcoholic fatty liver and chronic viral hepatitis have a high prevalence in the German population. They are associated with significantly increased occupational disability and mortality. Elevated levels of GGT or ALT can be found in about 10 % of the general population. Attempts to identify an underlying diagnosis often remain unsuccessful. In selected cases CDT can be helpful to confirm or rule out suspected alcohol-abuse. Recent studies showed that non alcoholic steatohepatitis (NASH) is a potentially severe complication of diabetes and its metabolic precursors. Treatment options for chronic viral hepatitis get more and more sophisticated, but the rates of sustained cure are still unsatisfactory, especially in hepatitis B with negative HBe-antigen and the hepatitis C genotypes 1, 4 and 5. Life long suppression of HBV replication by nucleoside analogues seems to prevent liver cirrhosis, but may become a great burden on health costs. The risk assessment of HBV carriers and of patients with successfully treated viral hepatitis should rely on the expertise of experienced physicians.