Description

Autoimmune hepatitis is a disease of the liver that occurs when the body's immune system attacks the liver. This can cause swelling, irritation, and liver damage. The exact cause of autoimmune hepatitis is unclear, but genetic and environmental factors appear to interact over time to trigger the disease.

Untreated autoimmune hepatitis can lead to scarring of the liver, called cirrhosis. You can also eventually lead to liver failure. When it is diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.

A liver transplant may be an option when autoimmune hepatitis is not responding to medications or liver disease becomes advanced.

Symptoms

The symptoms of autoimmune hepatitis vary from person to person and can come suddenly. Some people have few, if any, recognized the problems in the early stages of the disease, while others experience symptoms that may include:

  • Fatigue.
  • Belly discomfort.
  • Yellowing of the skin and whites of the eyes, called jaundice. Depending on the color of the skin, this change may be more difficult or more easy to see.
  • An enlarged liver.
  • Irregular blood vessels in the skin, called angiomas spider.
  • Rash on the skin.
  • Pain in the joints.
  • Loss of menstrual periods.

When to see a doctor

Make an appointment with a health care professional if you have any symptoms that worry you.

Causes

Autoimmune hepatitis occurs when the body's immune system, which tends to attack the viruses, bacteria and other causes of illness, rather than targets the liver. This attack in the liver can lead to long-lasting inflammation and severe damage to the liver cells. Why is the body turns against itself, it is clear, but the researchers think that autoimmune hepatitis can be caused by the interaction of the genes that control the function of the immune system and exposure to viruses or drugs.

Types of autoimmune hepatitis

Experts have identified two major forms of autoimmune hepatitis.

  • Type 1 autoimmune hepatitis. This is the most common type of the disease. It can occur at any age. Approximately half of the people with autoimmune hepatitis type 1 have other autoimmune disorders, such as celiac disease, rheumatoid arthritis, or ulcerative colitis.
  • Type 2 autoimmune hepatitis. Although adults can develop type 2 autoimmune hepatitis is more common in children and young people. Other autoimmune diseases may accompany this type of autoimmune hepatitis.

Risk factors

Factors that may increase your risk of autoimmune hepatitis include:

  • The fact of being a woman. Although both men and women can develop autoimmune hepatitis, the disease is most common in women.
  • Genetics. The evidence suggests that a predisposition to autoimmune hepatitis may be hereditary.
  • Having an autoimmune disease. People who already have an autoimmune disease, like celiac disease, rheumatoid arthritis, or hyperthyroidism (Graves disease or Hashimoto thyroiditis), may be more likely to develop autoimmune hepatitis.

Complications

Autoimmune hepatitis that is not treated can cause permanent scarring of liver tissue known as cirrhosis. Complications of cirrhosis include:

  • Dilated veins in the esophagus called esophageal varices.The portal vein carries blood from the intestine to the liver. When the circulation through the portal vein is blocked, blood can be made in other blood vessels, primarily the stomach and into the esophagus. These blood vessels have thin walls. And because they are filled with more blood from which they are made to carry, it is more prone to bleeding. Massive bleeding in the esophagus or in the stomach of these blood vessels is a life-threatening emergency that needs immediate medical attention.
  • Fluid in the abdomen, called ascites (uh-SY-teez). Liver disease can cause large amounts of fluid accumulation in the abdomen. Ascites can be uncomfortable and can interfere with breathing. It is usually a sign of advanced cirrhosis.
  • Liver failure. Liver failure occurs when large damage to the liver cells, it is not possible that the liver is working well. At this point, a liver transplant is necessary.
  • Cancer of the liver. People with cirrhosis have an increased risk of liver cancer.

Dilated veins in the esophagus called esophageal varices. The portal vein carries blood from the intestine to the liver. When the circulation through the portal vein is blocked, blood can be made in other blood vessels, primarily the stomach and into the esophagus.

These blood vessels have thin walls. And because they are filled with more blood from which they are made to carry, it is more prone to bleeding. Massive bleeding in the esophagus or in the stomach of these blood vessels is a life-threatening emergency that needs immediate medical attention.

Diagnosis

Tests and procedures used to diagnose autoimmune hepatitis include:

  • Blood tests. The testing of a blood sample for antibodies can distinguish autoimmune hepatitis from viral hepatitis and other diseases with similar symptoms. The antibody tests also help determine the type of autoimmune hepatitis you have.
  • The liver biopsy. A sample of liver tissue may be taken to confirm the diagnosis and determine the type and degree of damage in the liver. During the biopsy procedure, a fine needle is passed into the liver through a small incision in the skin. The needle is used to take a small sample of tissue from the liver. The sample is sent to a laboratory for analysis.

Treatment

The goal of the treatment of autoimmune hepatitis is to slow or stop the attack of the immune system in the liver. This can help you to increase the time before the disease gets worse. To meet this goal, it is likely that you need medicines that reduce the activity of the immune system. The first treatment is usually prednisone. A second drug, azathioprine (Azasan, Imuran), may be recommended in addition to the prednisone.

Prednisone, especially when taken long term, can cause a wide range of serious side effects, such as diabetes, weakened or broken bones, high blood pressure, cataracts, glaucoma, and weight gain.

Health professionals often prescribe prednisone a high dose for about the first month of treatment. Then, to reduce the risk of side effects, reduce the dosage gradually over the next few months until you get to the lowest possible dose that controls the disease. The addition of azathioprine also helps to avoid the prednisone side effects.

Although you may experience a remission of a couple of years after starting treatment, the disease often returns if the drug is discontinued. Depending on your situation, you may need treatment for life.

Liver transplant

When medications do not stop the worsening of the disease or scars that can't be reversed, called cirrhosis, or liver failure, the only option is a liver transplant.

During a liver transplant, the diseased liver is removed and replaced with a healthy liver from a donor. Liver transplants more frequently the use of livers from deceased organ donors. In some cases, a live donor liver transplant can be used. During a living-donor liver transplant, you receive only a part of a healthy liver from a living donor. Both the livers begin the regeneration of new cells almost immediately.

Preparing for your appointment

If you have any symptoms that worry you, start by making an appointment with someone in the team of primary health care. If your health care team suspects that you may have autoimmune hepatitis, you may be referred to a specialist in diseases of the liver. This type of specialist is called a hepatologist.

Because appointments can be brief and there's often a lot to discuss, it is a good idea to be prepared for your appointment. Here's some information to help you to be prepared and know what to expect.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Have a family member or a friend to help you remember everything that was discussed.
  • Write questions to ask their care team.

For autoimmune hepatitis, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What evidence do I need to confirm that I have autoimmune hepatitis?
  • How serious is the damage to my liver?
  • Is my condition likely temporary or chronic?
  • What are my treatment options?
  • The treatment can cure my autoimmune hepatitis?
  • What are the possible side effects of each treatment option?
  • How could the treatment for autoimmune hepatitis affects the management of my other medical conditions?
  • Could any of my medications or habits are cause of my liver problems or make my liver problems worse?
  • Are there restrictions in the diet should I follow?
  • You should see a specialist?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • How often will I need follow-up visits?

What to expect from your doctor

You'll likely be asked a few questions during the appointment. Be ready to answer them may reserve time to go over any points you want to spend more time on. You may ask:

  • When did you first begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Nothing seems to improve or worsen your symptoms?
  • Are you taking any medications or treatments to relieve their symptoms?
  • Do you have a family history of liver disease?
Symptoms and treatment of Autoimmune hepatitis