Digestive System Disorders. Autoimmune Hepatitis

Autoimmune Hepatitis

I Have Heard Of Hepatitis Before, But What Exactly is Autoimmune Hepatitis?

Autoimmune Hepatitis is a potentially life threatening disease in which the body's immune system attacks the liver cells. Like other autoimmune diseases such as Ulcerative colitis, this attack causes inflammation and is also considered a chronic condition. If left untreated over time, this disease can lead to cirrhosis scarring and hardening (cirrhosis) of the liver and eventually liver failure. Autoimmune Hepatitis also has classifications such as type 1 and type 2. In Type 1 Autoimmune Hepatitis, half of the patients have other autoimmune disorders such as Ulcerative Colitis, type 1 diabetes, autoimmune anemia, Graves' disease, Sjögren's syndrome, thyroiditis and proliferative glomerulonephritis. Type 2 Autoimmune Hepatitis is less common and mostly affects girls ages 2 to 14; however this type can also be found in adults.

What Are The Symptoms Of Autoimmune Hepatitis?

Symptoms of autoimmune hepatitis range from mild to severe and include fatigue, abdominal discomfort, joint pain, skin rash, enlarged liver, jaundice, itching, nausea, vomiting, dark urine, loss of appetite, abnormal blood vessels on the skin, fatigue and pale or gray colored stools. Mental confusion and fluid in the abdomen can more likely be found in patients with advanced stages of the disease. Please note that the symptoms of viral hepatitis and other forms of hepatitis that are caused by a drug such as certain antibiotics are similar. With this in mind, other tests may be needed by a physician to rule out these other forms of disease.

How is Autoimmune Hepatitis Diagnosed?

Diagnosis of autoimmune hepatitis is based on symptoms as well as a liver biopsy and blood tests. For a liver biopsy, the patient goes to an outpatient surgical center or hospital. In the procedure, the physician will take a small sample of liver tissue to examine under a microscope. This examination will accurately diagnose autoimmune hepatitis and it's seriousness. While routine blood tests can reveal a pattern that is typical in hepatitis cases, further blood test are needed to diagnose autoimmune hepatitis especially for autoantibodies. The pattern and level of antibodies help define if the disease is a type 1 or type 2 classification. These tests will also help distinguish autoimmune hepatitis from a metabolic disorder or from the other forms of hepatitis.

How Is Autoimmune Hepatitis Treated?

Treatment for autoimmune hepatitis works best when it is diagnosed early and consists primarily of medications that suppress the overactive immune system. For both types of disease, the physician will prescribe prednisone, which is a corticosteroid. Doses of the medicine may be high when first prescribed (about 20 to 60 mg per day) but later tapered off to lower doses (5 to 15 mg/day) as the disease is controlled. The lowest possible dose that will control the disease is desirable. Prednisone, as well as other corticosteroid may have some unpleasant side effects. These side effects increased acne, filling or rounding out of the face, weight gain, thinning of bones, thinning of hair and skin, high blood pressure, diabetes, cataracts, glaucoma, depression, anxiety and confusion. Athzathioprine (Imuran) is another medication that is prescribed in the treatment of autoimmune hepatitis. Like prednisone, this medicine is also used to suppress the immune system as well as helping lower the doses of prednisone needed while reducing it's side effects. Once the disease is under control, the physician may prescribe azathioprine, in addition to prednisone. Possible side effects of azathioprine may include lowered blood cell count, nausea and poor appetite. Rare side effects include an allergic reaction, pancreatitis and liver damage. The duration of treatment varies from individual to individual in that some may eventually stop treatment followed by close monitoring to having treatment for life. However, for those whose treatment has been stopped, it is possible that the disease may return and be even more severe, especially during the first few months after stopping treatment. Within 2 years of starting treatment, 7 out of 10 people will have the disease go into remission. However, the symptoms will return within 3 years, so treatment for autoimmune hepatitis is an ongoing process. Other treatments are also possible for those patients who do not respond to standard immune therapy or who have severe side effects. These include medicines such as tacrolimus, cyclosporine or mycophenylate mofetil, which are also immunosuppressive agents. Liver transplants are needed for those with cirrhosis and or end stage liver disease.

Digestive System Disorders

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Autoimmune Hepatitis