Clinical and Experimental Hepatology
eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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abstract:
Original paper

Hepatitis E virus infection in a single center in Japan

Kohei Ashina
1
,
Hidehiro Kamezaki
2
,
Nana Yamada
2
,
Terunao Iwanaga
2
,
Takafumi Sakuma
2
,
Koji Takahashi
2
,
Junichi Senoo
2

  1. Department of Respiratory Medicine, Eastern Chiba Medical Center, Chiba, Japan
  2. Department of Gastroenterology, Eastern Chiba Medical Center, Chiba, Japan
Clin Exp HEPATOL 2026; 12, 1
DOI: https://doi.org/10.5114/ceh.2026.158807
Online publish date: 2026/02/06
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Aim
Hepatitis E virus (HEV) is an emerging cause of acute hepatitis in developed countries. Older adults may be prone to symptomatic disease due to age-related vulnerability or underlying conditions. Limited data exist regarding risk factors, clinical outcomes, and liver fibrosis markers in elderly populations.

Material and methods
We conducted a single-center retrospective review between January 1, 2016, and March 31, 2025. Patients diagnosed with acute HEV infection were included. The FIB-4 index was calculated 3-6 months after clinical recovery and used as a descriptive, exploratory indicator rather than a diagnostic test.

Results
Eight patients met the inclusion criteria, with a median age of 68 years (IQR: 63.5-70.5); six (75%) were male. One asymptomatic case was identified through routine blood donor screening. Comorbidities included hypertension (n = 3) and diabetes mellitus (n = 1). Two patients reported regular alcohol consumption. Among symptomatic patients, the median FIB-4 index was 2.00 (IQR: 1.65-3.08), compared to 1.61 in the asymptomatic patient. Six patients required hospitalization for a median of 17.5 days (IQR: 12-27). One patient received steroid pulse therapy. All patients recovered, with no progression to chronic hepatitis.

Conclusions
In this small cohort, most HEV cases occurred in older men. Post-recovery FIB-4 values were numerically higher among symptomatic cases, but this observation is descriptive and hypothesis-generating; the FIB-4 index should not be used during the acute phase. HEV should be considered in older adults presenting with acute liver dysfunction, regardless of dietary or travel history, and fibrosis assessment – when clinically indicated – should rely on comprehensive noninvasive approaches rather than a single score.

keywords:

hepatitis E virus, acute hepatitis, FIB-4 index, hepatic fibrosis, elderly
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