What is Autoimmune Hepatitis?
Autoimmune hepatitis is a rare but serious liver disease in which the body’s immune system mistakenly attacks its own healthy liver cells, mistaking them for infected cells. This leads to inflammation in the liver, which, if left untreated, can progress to cirrhosis (scarring) and eventually liver failure. Severe liver damage may necessitate a liver transplant.
Autoimmune hepatitis is classified into two types:
- Type 1: Commonly diagnosed in teenagers and adults, particularly in North America.
- Type 2: Primarily diagnosed in children and can be more challenging to treat.
What Causes Autoimmune Hepatitis?
The exact cause of autoimmune hepatitis is unknown. It can develop suddenly or gradually over time. In some cases, it may be associated with other systemic diseases or exposure to certain medications. There may also be a genetic component, as the condition can be inherited from a parent or grandparent who has the disease.
Symptoms and Diagnosis
Common symptoms of autoimmune hepatitis may include fatigue, jaundice (yellowing of the skin and eyes), joint pain, and abdominal discomfort. Diagnosis typically involves blood tests to check for specific antibodies and liver function, as well as imaging studies and sometimes a liver biopsy to assess the extent of liver damage.
Treatment
Autoimmune hepatitis is treated with medications that suppress the immune response, such as corticosteroids and other immunosuppressants. Regular monitoring and follow-up care are essential to manage the condition effectively and prevent complications.
What are the Symptoms of Autoimmune Hepatitis?
The disease affects each patient differently. Some patients may have no symptoms, while others may experience symptoms such as:
- Fatigue / Low Energy
- Nausea
- Itchy Skin or Rash
- Yellowing of the Skin or Eyes (Jaundice)
As liver damage continues and liver function worsens, the patient may notice:
- Joint Pain
- Abdominal Pain
- Swollen Belly
- Bruising and Bleeding
- Vomiting
- Dark Urine
- Pale Stools
- Menstrual Irregularities in Women
How is Autoimmune Hepatitis Diagnosed?
The symptoms of autoimmune hepatitis may be mild at first and resemble those of the flu, so it may not be diagnosed immediately. The gastroenterologist will perform a physical examination and ask about the patient’s family medical history. The doctor may also order several tests, including:
- Blood tests to check for liver inflammation, assess liver function, and screen for antibodies related to autoimmune hepatitis.
- Liver ultrasound. This procedure uses high-frequency sound waves to create images of the liver.
- If necessary, the doctor may also order a liver biopsy, which involves removing a small piece of liver tissue for laboratory analysis to check for disease.
How is Autoimmune Hepatitis Treated?
Once autoimmune hepatitis is diagnosed, a doctor will prescribe medications to stop the attack of antibodies and heal the inflamed liver. The treatment usually involves a high dose of a steroid (prednisone or prednisolone) to suppress the immune system and prevent it from attacking the liver. The doctor may also prescribe azathioprine to further suppress the immune response.
As the condition improves, the doctor may reduce the dosage of medications. If the condition does not improve, other immunosuppressive drugs may be needed.
Patients may need to undergo treatment for several years before the disease goes into remission (reducing or disappearing), at which point the medications may be discontinued. If there is a relapse (return of the disease), long-term medication may be necessary.
If medications do not adequately manage autoimmune hepatitis and the patient develops cirrhosis or liver failure, a liver transplant may be required.
Can Autoimmune Hepatitis be Prevented?
Autoimmune hepatitis cannot be prevented.
Who is at Risk for Autoimmune Hepatitis?
Autoimmune hepatitis affects about one in 100,000 people. The disease is more common in women than in men, with women typically diagnosed in their 40s or 50s. Girls aged between two and 14 years may also suffer from the disease.
Those with other autoimmune conditions, such as diabetes, rheumatoid arthritis, thyroid disease, and celiac disease, are also at higher risk of developing autoimmune hepatitis (just as those with autoimmune hepatitis have a higher risk of developing other autoimmune diseases).
Individuals with a family history of autoimmune hepatitis are also at increased risk for the disease.
What is the Prognosis for Patients with Autoimmune Hepatitis?
If autoimmune hepatitis is diagnosed early and treated with the appropriate medication, the liver can begin to heal and regenerate healthy cells to replace the inflamed and scarred ones. The patient’s symptoms may improve, and liver function can return to normal.
Patients will need ongoing monitoring and management for the rest of their lives, even if they feel better and liver function improves. In many cases, the patient may require lifelong medication.