Autoimmune hepatitis in adults

What is autoimmune hepatitis

Autoimmune hepatitis is a rather serious, severe and chronic disease in which the immune system of our body, for some reason that is still completely clear, attacks the liver and causes inflammation and damage to its tissue.

Without treatment, autoimmune hepatitis can gradually become more severe and lead to complications, including the development of cirrhosis and liver failure.

Specialists have identified two types of autoimmune hepatitis: type 1 and type 2. The immune system produces different auto-antibodies for each type of lesion. Type 1 autoimmune hepatitis is much more common than type 2, which mostly occurs in children.

Studies in the Nordic countries have shown that between 10 and 24 out of 100 people in this region have autoimmune hepatitis. In addition, the disease is known to be common among Alaska Natives, affecting about 000 people out of 43.

Causes of autoimmune hepatitis in adults

Scientists and doctors don’t know exactly what causes autoimmune hepatitis. Research shows that the likelihood of developing autoimmune diseases (not just hepatitis, but others) in some people is increased by certain genes that we inherit from our parents. In people with these genes, some harmful environmental factors can trigger an autoimmune reaction that causes their immune system to attack the liver (or other organs and tissues). Researchers are still studying environmental triggers that play a role in the development of autoimmune hepatitis. These triggers may include certain viruses and medications.

Who is more susceptible to autoimmune hepatitis

Autoimmune hepatitis can occur at any age and affects people of all racial and ethnic groups. The disease is more common in girls and women than in boys and men. Autoimmune hepatitis type 1 occurs in people of all ages, while type 2 affects children more often.

Some people with autoimmune hepatitis may also have other signs of liver disease that affect the bile ducts. These are primary biliary cholangitis, primary sclerosing cholangitis, and bile duct problems that cannot be classified.

People with autoimmune hepatitis are at risk for other autoimmune diseases. They may develop celiac disease, thyroid disease (including Graves’ disease and Hashimoto’s disease), rheumatoid arthritis, type 1 diabetes, inflammatory bowel disease (such as ulcerative colitis), or vitiligo.

Symptoms of autoimmune hepatitis in adults

People with autoimmune hepatitis may have the following symptoms:

• pain over the liver, in the upper abdomen;
• yellowish color of the whites of the eyes and skin, called jaundice;
• dark urine color;
• lightening the color of the stool;
• feeling tired;
• joint pain;
• nausea;
• poor appetite;
• skin conditions such as rashes, psoriasis, vitiligo or acne.

Symptoms of autoimmune hepatitis can range from mild to severe. Some people have no symptoms. In such cases, doctors may find evidence of illness during routine blood tests. People who are asymptomatic at the time of diagnosis may develop symptoms later. Some patients with autoimmune hepatitis do not have symptoms until complications from cirrhosis develop. It can be suspected by the following signs:

• feeling tired or weak;
• weight loss without changes in diet and activity;
• bloating due to a buildup of fluid in the abdomen, called ascites
• swelling of the legs, ankles, or feet;
• itchy skin;
• jaundice.

Treatment of autoimmune hepatitis in adults

Doctors diagnose autoimmune hepatitis based on a medical history, physical examination, and tests. It is necessary to determine the form and severity of the disease as accurately as possible in order to develop treatment tactics.

Diagnostics

The doctor will ask about symptoms and factors that may have damaged the liver. For example, any medications or herbal products you are taking and how much alcohol you are drinking. And also about your other autoimmune diseases, such as inflammatory bowel disease or thyroid disease.

A doctor may order one or more blood tests to diagnose autoimmune hepatitis. Blood tests include tests that check levels of the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST), and check for autoantibodies such as antinuclear antibodies (ANA) and anti-smooth muscle antibodies (SMA). ALT and AST are especially important because these liver enzymes are highly elevated. Doctors check ALT and AST levels to monitor disease progression and response to treatment.

The doctor may also prescribe an ultrasound of the abdomen and liver. An ultrasound can show if the liver is enlarged, has an irregular shape or texture, or if the bile ducts are blocked.

Sometimes computed tomography (CT) is used to show the size and shape of the liver and spleen, as well as the presence of cirrhosis.

Magnetic resonance imaging (MRI) may also be prescribed – it can show the shape and size of the liver and reveal signs of cirrhosis.

Another research method is a biopsy. In this case, a piece of the liver is taken from the patient and examined under a microscope to determine the extent of damage and features of the disease, to look for signs of autoimmune hepatitis, and to check the amount of scarring to find out if you have cirrhosis.

Modern treatments

The main goal of treatment is to stop liver inflammation by suppressing the immune system. This therapy improves liver function, reduces scarring, and helps prevent long-term liver damage and liver failure. But it can also lower the immune system’s ability to fight infection.

Treatment is carried out for at least 2 years, but often it lasts a lifetime. If it is stopped, a relapse (recurrence) may occur.

The steroid drug Prednisolone is often used to treat autoimmune hepatitis, which suppresses the immune system, helping to reduce inflammation in the liver.

Another drug is the immunosuppressant Azathioprine. It is used to treat autoimmune hepatitis and other chronic inflammatory and autoimmune conditions. Azathioprine suppresses the immune system, similar to prednisolone, by reducing liver inflammation.

Inflammation can be well controlled in most people using a combination of steroids and azathioprine. For some people, steroids can be stopped and Azathioprine is sufficient to control the disease. However, some patients do not tolerate these drugs or they are not effective enough. There are other medications that liverworts can use, but they also have side effects. Only a doctor can prescribe them.

Prevention of autoimmune hepatitis in adults at home

Prevention of liver diseases basically comes down to the general rules of a healthy lifestyle.

Don’t drink alcohol. This toxin is dangerous for everyone, and even more so for people with a diseased liver.

Do not smoke. Smoking can increase liver damage. People with liver disease are more vulnerable to infections and generally have poor health, so smoking or secondhand smoke is a risk.

Lose weight. Being overweight or obese can exacerbate liver disease and reduce the effectiveness of treatment.

Discuss your medications with your doctor. Most drugs are processed by the liver, so they can be toxic to people with liver problems. Some of them can damage the liver and make the disease worse. Before taking any drug, consult your doctor.

Popular questions and answers

We discussed issues related to autoimmune hepatitis C gastroenterologist Marat Zinnatullin.