saudigastro.com/patients/hepatitis-e
Category
Common
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Hepatitis means inflammation of the liver. Hepatitis E is caused by the hepatitis E virus (HEV). In most people it causes a short illness that settles within weeks, without lasting liver damage. In some groups, it can be more severe. Rarely, in people whose immune system is weakened, such as after an organ transplant, the infection can become long-lasting (chronic).
How common is it?
Hepatitis E occurs worldwide. It is more common in places where clean water and sanitation are limited. In other regions, occasional cases are linked to certain undercooked meats. Many infections cause no symptoms and are never diagnosed.
Why does it happen?
The virus usually spreads by the fecal-oral route: swallowing water or food contaminated with stool containing the virus. Eating undercooked or raw pork, game or shellfish can also pass it on in some regions. Person-to-person spread is uncommon. It can pass from a pregnant mother to her baby. It is not spread by casual contact such as shaking hands.
Symptoms
- Tiredness and general weakness
- Loss of appetite, nausea and vomiting
- Mild fever and aching muscles or joints
- Pain in the upper right part of the abdomen
- Dark urine and pale stools
- Jaundice (yellowing of the skin and the whites of the eyes)
- Itchy skin
Red flags — seek urgent medical care
Confusion, unusual sleepiness or behavior change
May mean the liver is failing. Go to the emergency department now.
Bleeding or easy bruising, or vomiting blood
The liver may not be making clotting proteins. Seek emergency care.
Jaundice or hepatitis symptoms during pregnancy
Hepatitis E can be severe in pregnancy. Contact your doctor or go to the hospital the same day.
Persistent vomiting with inability to drink
Risk of dehydration. See a doctor urgently.
Jaundice that lasts for weeks, or abnormal liver tests in a person with a transplant or on immune-suppressing drugs
The infection may have become chronic. Tell your specialist.
How is it diagnosed?
Blood tests show liver inflammation (raised liver enzymes) and can detect antibodies to the virus or the virus itself (HEV RNA). Because several viruses and other causes can look the same, the doctor usually also tests for hepatitis A, B and C and reviews medicines and alcohol use. In people with weakened immunity, a test for the virus itself is important, because antibody tests can be unreliable.
Outlook — what to expect
Most people recover fully within a few weeks to a couple of months and become immune afterwards. Severe illness is uncommon but is more likely in pregnancy and in people with existing liver disease. Chronic infection in people with weak immunity can usually be treated and is followed by a specialist.
Treatment
Habits & Lifestyle
Rest and prevention of spread are the main steps for most people.
- Rest and return to activity gradually as energy returns
- Wash hands with soap and water after the toilet and before preparing food
- Avoid alcohol until your doctor says your liver has recovered
- Do not prepare food for others while you have symptoms
Diet
There is no special diet; the goal is to eat and drink enough and to eat safely.
- Eat small, frequent meals if you feel nauseated
- Drink plenty of fluids to avoid dehydration
- Cook meat, especially pork and game, and shellfish thoroughly
- Use safe, clean drinking water and wash fruit and vegetables with safe water
Medications
There is usually no specific medicine for acute hepatitis E. Your doctor decides about any treatment.
- Check with your doctor or pharmacist before using any medicine, including herbal products, because the liver is inflamed
- Be careful with paracetamol (acetaminophen) and follow medical advice on safe use
- In chronic infection in people with weak immunity, doctors may reduce immune-suppressing drugs or use an antiviral medicine
Procedures & Surgery
Procedures are not needed for most people.
- Hospital care with monitoring for those who are very unwell or pregnant
- Liver transplant assessment in the rare case of acute liver failure
In the Saudi context
Travel to areas with limited safe water carries a higher risk. Pilgrims and travelers should drink bottled or properly treated water, eat freshly cooked food and wash hands carefully. Pork is not consumed by Muslims, but contaminated water or raw shellfish can still be a source.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How do you know this is hepatitis E and not another cause?
- When will my liver tests return to normal?
- When can I return to work, school and exercise?
- Do my family members need to do anything?
- I am pregnant or on immune-suppressing drugs; what should I do?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide