Autoimmune Hepatitis: The Basics

What is autoimmune hepatitis?

Hepatitis refers to an inflammation of the liver cells. Many types of hepatitis are caused by viruses but the autoimmune form is an exception. It occurs when the immune system accidentally attacks the liver cells. It is a long-lasting condition that can lead to liver scarring or cirrhosis, and ultimately, liver failure.

Autoimmune hepatitis
Photo Credit: Mayo Clinic

Causes of autoimmune hepatitis

This condition develops when the immune system accidentally views your liver cells as foreign and then makes antibodies to fight them. The exact cause of this condition is not known but some risk factors have been identified and these include:

  • Family history of autoimmune hepatitis
  • History of infection, either bacterial or viral
  • Female gender
  • The use of certain drugs such as minocycline

The symptoms of liver disease can be caused by other autoimmune conditions and having them also increases the likelihood of developing autoimmune hepatitis. They include:

  • Grave’s disease
  • Type 1 diabetes
  • Thyroiditis
  • Rheumatoid arthritis
  • Scleroderma
  • Inflammatory bowel disease
  • Systemic lupus erythematosus
  • Sjogren’s syndrome

Types of autoimmune hepatitis

Two types of this condition have been recognized from serum tests namely:

  • Type 1, it is the commoner form, occurs more in younger women and is related to other autoimmune diseases. It is the commonest form in the United States
  • Type 2, mainly affects girls that are between the ages of 2 and 14

Although AIH usually occurs in teenage years or early adulthood, it can happen at any age.

Symptoms of AIH

The symptoms of this condition vary in severity, ranging from mild to very severe. The onset may be symptomless but symptoms can just appear suddenly in later stages. Symptoms could also develop gradually over time.

The symptoms of autoimmune hepatitis include:

  • Increase in liver size, known as hepatomegaly
  • Unusual blood vessels appearing on the skin, known as spider angiomas
  • Distended abdomen
  • Dark urine
  • Pale-colored stool

Extra symptoms may include:

  • Yellowish discoloration of the skin and mucous membranes
  • Pruritus, meaning itching, it is due to bile accumulation
  • Fatigue
  • Appetite loss
  • Vomiting
  • Joint pain
  • Abdominal discomfort

Diagnosis

Autoimmune hepatitis is easily confused for other liver conditions such as viral hepatitis. Blood testing is needed for a proper diagnosis to be made as it will do the following:

  • Exclude the presence of viral hepatitis
  • Specify the type of autoimmune hepatitis you have
  • Check your liver function

Immunoglobulin G (IgG) antibodies help the body to fight infection and inflammation, blood tests will help to measure the quantity of IgG At times, a liver biopsy may be needed to diagnose AIH. This is performed by using a long needle to take a small piece of liver tissue and sending to the laboratory for testing.

Treatment of AIH

The treatments instituted can slow down, stop, or reverse the ongoing liver damage. About 65 to 80 percent of those with AIH will undergo remission with treatment though it can take up to three years for that to happen.

Immunosuppressant drugs

These are used to halt the attack by the immune system. Examples of such drugs include mercaptopurine and azathioprine. However, taking immunosuppressant drugs can affect the body’s ability to fight infections.  

Corticosteroids

Prednisolone, a corticosteroid is used to treat liver inflammation. They also function as immunosuppressants. For autoimmune hepatitis, prednisolone is taken for at least 18 to 24 months. Some people even have to take it life-long to prevent a recurrence.

Prednisolone can manifest various side effects such as diabetes, osteoporosis, hypertension, and weight gain.

Liver transplant

Autoimmune hepatitis can be treated by a liver transplant but the disease can still recur after transplant. The National Institute of Diabetes and Digestive and Kidney Diseases report that the one-year survival rate of those who have a transplant is 86 percent, and it is about 72 percent for a five-year survival rate.

Complications of autoimmune hepatitis

The likely complications of this condition include:

  • Liver failure
  • Liver scarring or cirrhosis
  • Liver cancer
  • Portal hypertension, a condition where there is increased pressure in the portal vein which is responsible for supplying blood to the liver.
  • Vein enlargement in the stomach and esophagus (esophageal varices).
  • Accumulation of fluid in the abdomen ascites.

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