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Autoimmune Hepatitis - Types, Cause, Diagnosis, and Treatment

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Autoimmune hepatitis occurs when the body’s defense system attacks the liver leading to inflammation of its cells. To know more, read the article.

Written by

Dr. Akanksha

Medically reviewed by

Dr. Ghulam Fareed

Published At September 28, 2022
Reviewed AtFebruary 2, 2023

Introduction:

The body’s defense system or immune system works against any kind of germs, for example, pathogens, bacteria, or viruses that enter the body and attack it in order to protect healthy cells from getting infected. But when this immune system starts attacking the normal cells instead of attacking germs, it leads to an autoimmune disorder. There are multiple types of autoimmune diseases. They can affect one single organ or multiple organs at one time. When liver cells are infected cells, it is called autoimmune hepatitis.

What Is Autoimmune Hepatitis?

Autoimmune hepatitis is a disorder of the liver, which is situated on the right side of the abdominal cavity, wherein one’s own immune system attacks the cells. It is a non-communicable disease and lasts for a longer period. It needs to be checked and kept under observation for life. Women are at a major risk of getting infected more than men. It is a hereditary disorder that runs over generations. It is usually associated with other autoimmune diseases like rheumatoid arthritis, celiac disease, or type 1 diabetes. It leads to inflammation of liver cells, which might lead to a condition called cirrhosis (healthy liver cells replaced by scarred liver cells), leading to permanent damage to the liver and increasing the chances of liver transplant or death. Having said that, the exact cause of autoimmune hepatitis is not clearly known.

What Are the Types of Autoimmune Hepatitis?

  • Type 1 (Classic Type) - It is usually found in adulthood.

  • Type 2 - Found in early years of age. It happens to be more critical and tough to control.

What Are the Signs and Symptoms of Autoimmune Hepatitis?

The signs and symptoms might be different for different people. Some might not even witness any symptoms. The common sign and symptoms are:-

  • Exhaustion (fatigue).

  • Pricking and itchy skin (pruritus).

  • Yellow skin and whites of eyes (jaundice).

  • To feel sick in the stomach (nausea).

  • Abdominal pain.

  • Rashes.

  • Absence of menstruation in women.

  • Pain in joints.

  • Increased size of liver (hepatomegaly).

  • Increased size of spleen (splenomegaly).

What Is the Cause of Autoimmune Hepatitis?

The accurate cause of this disorder is unrecognized as of now. Since it is an autoimmune disease, somehow, something activates the defense mechanism of the body to think that the liver cells are harmful and attacks them, leading to inflammation of the liver cells and damage to the liver. Medicines like Statins or antibiotics such as Minocycline, stress, and viral infections like hepatitis, herpes, and measles can trigger the immune system. Some believe that it might be caused due to interaction of genes. People with weak immune systems are more vulnerable to the disease.

How to Diagnose Autoimmune Hepatitis?

The diagnosis of autoimmune hepatitis is pretty complex and requires multiple steps to rule out other reasons for liver damage.

  1. Case History - When a person visits a doctor after noticing the symptoms, the doctor will ask for some information like any medical condition that he or she is already suffering from, stress history, alcohol drinking habit, and its frequency. The doctor would ask the patient to go for a physical examination and complete a blood test and liver biopsy.

  2. Blood Tests - Blood tests will include liver function tests and antibody tests, among others. This will help in checking the inflammation of the liver. Increased levels of antibodies such as an antinuclear antibody (ANA) and IgG antibody indicate the cause of damage is an autoimmune disorder. However, it is not indicative of autoimmune hepatitis. Prothrombin time, albumin levels, and bilirubin levels are also checked for the proper functionality of the liver. Other blood tests are also done to rule out any other infections of the liver, like hepatitis A, B, C, D, E, and blood alcohol levels.

  3. Biopsy - For the confirmation of autoimmune hepatitis, a liver biopsy is conducted. Using a biopsy needle, liver tissue is removed and sent to a path laboratory, where it is placed under a microscope, and a thorough examination is done to find out about the condition of the liver. This procedure is done under local anesthesia, and hence it is not painful. This test is very important for making the final diagnosis. At times, a fibroscan is recommended to assess the health of the liver to determine the amount of fibrosis (scar tissue of the liver). However, a fibroscan cannot be performed on every patient.

What Are the Treatments of Autoimmune Hepatitis?

The treatment plan usually differs from patient to patient. Every patient reacts differently to the line of treatment. Doctors do not recommend any treatment until there are any visible symptoms. Treatment starts if symptoms can be seen or the blood test reports are bad.

1) Medication -

  • In order to subside the inflammation of liver cells, the most common drug used is a corticosteroid named Prednisone. A higher dose of Prednisone is prescribed, and the dosage is lowered along the course of treatment. Another drug called Azathioprine or Purinethol, also a corticosteroid, would be added to the line of treatment after lowering the dose of Prednisone.
  • The alternative treatment to Azathioprine is Cyclosporine and Tacrolimus. People may have side effects because they are under steroid medication, such as weak bones, high blood sugar levels, and increased urge to eat, leading to increased weight, eye problems, anxiety, and depression.
  • After treatment of about three years, the majority of the patient's symptoms and blood tests are under the normal range. Few doctors recommend immunosuppressants for life, or else recurrence rates are really high. Few others recommend that patients can stop medication after the symptoms have subsided and blood reports are normal, but the patient has been continuously being observed by their doctor, and their medication would start again once there is a relapse.

2) Lifestyle and Dietary Changes - Lifestyle changes are very important to maintain a healthy condition of the liver. Quitting alcohol and eating a balanced diet are advised. Patients should also do some kind of physical exercise.

3) Surgery- In severe cases, when cirrhosis of the liver is diagnosed and reports suggest liver damage, a liver transplant surgery is recommended. A liver transplant involves replacing the damaged liver with the donor’s healthy liver.

Conclusion:

It is always suggested by doctors to go for regular checkups, as any disease diagnosed at an early stage can be prevented from going worse and spreading to other organs of the body. Even with autoimmune hepatitis, early diagnosis can prevent severe liver damage, and the disease can be controlled.

Frequently Asked Questions

1.

What Is Autoimmune Hepatitis?

Autoimmune hepatitis is a chronic liver disorder wherein the immune system attacks the liver cells. It results in inflammation and liver damage. It is a non-communicable disease and lasts for a more extended period. It needs to be checked and kept under observation for life.

2.

Can autoimmune hepatitis Be Treated?

The treatment plan differs from patient to patient. Every patient reacts differently to the line of treatment. Doctors recommend no treatment until symptoms are visible. If the disease shows signs or the blood test reports reveal the same, the treatment can be started.

3.

What Are the Signs of Autoimmune Hepatitis?

The typical sign and symptoms are:-
- Exhaustion (fatigue).
- Pricking and itchy skin (pruritus).
- Yellow skin and whites of eyes (jaundice).
- To feel sick in the stomach (nausea).
- Abdominal pain.
- Rashes.
- Absence of menstruation in women.
- Pain in joints.

4.

Who Is at Risk of Autoimmune Hepatitis?

Women are at a major risk of getting infected more than men. It is a hereditary disorder that runs over generations. It is usually associated with other autoimmune diseases like rheumatoid arthritis, celiac disease, or type 1 diabetes.

5.

How Does Autoimmune Hepatitis Occur?

The precise cause of this disorder has yet to be discovered. The etiology of this disease is not well understood; however, as in any other autoimmune disease, somehow, something activates the body's defense mechanism to mistake the liver cells to be foreign bodies and attacks them, leading to inflammation of the liver cells and damage to the organ.

6.

Is Autoimmune Hepatitis a Stress-Induced Condition?

The exact cause of autoimmune hepatitis is not known. Stress and viral infections like hepatitis, herpes, and measles can trigger the immune system. Some believe that it might be caused due to interaction of genes. People with weak immune systems are more vulnerable to the disease.

7.

What Can Trigger Autoimmune Hepatitis?

Medicines like statins or antibiotics such as Minocycline, stress, and viral infections like hepatitis, herpes, and measles can trigger autoimmune hepatitis. However, the body's defense or immune system works against any trigger, resulting in autoimmune hepatitis.

8.

Is Autoimmune Hepatitis Communicable?

Autoimmune hepatitis is a disorder of the liver. It is a non-communicable disease and lasts for a longer period. There are multiple types of autoimmune diseases. They can affect one single organ or multiple organs at one time.

9.

How Autoimmune Hepatitis Diagnosed?

Diagnosing autoimmune hepatitis is pretty complex and requires multiple steps to rule out other reasons for liver damage. To confirm autoimmune hepatitis, a liver biopsy is essential for making the final diagnosis.

10.

Does Autoimmune Disease Show Up in Blood Tests?

Blood tests will include liver function tests and antibody tests, among others. The test will help in checking the inflammation of the liver. Increased levels of antibodies such as an antinuclear antibody (ANA) and IgG antibody indicate the cause of damage is an autoimmune disorder. However, it is not indicative of autoimmune hepatitis.

11.

What are the things that should be avoided in autoimmune hepatitis?

Lifestyle changes are significant to maintain a healthy condition of the liver. Quitting alcohol and eating a balanced diet are advised. Patients should also do some physical exercise. Few others recommend stopping medication after the symptoms have subsided and blood reports are regular.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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