Autoimmune Hepatitis

What is autoimmune hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction. In autoimmune hepatitis, the body's own immune system destroys the cells of the liver. It is a chronic inflammatory liver disease with no known cause. It is associated with a disorder called hypergammaglobulinemia. Hypergammaglobulinemia is a disorder where there are too many circulating protein antibodies in the blood. A chronic infection or certain malignant blood diseases may cause hypergammaglobulinemia. Autoimmune hepatitis may resolve without treatment in some people, but, for the majority, it is chronic and can lead to cirrhosis and liver failure.

Autoimmune hepatitis may be classified as type 1 or type 2. Type 1 (classic) is the most common form. It may occur at any age but usually affects young women more than men. Also, other autoimmune disorders can be associated with type 1 such as thyroiditis, Grave's disease, and ulcerative colitis. Type 2 generally affects girls between ages two and 14, but does occur in adults.

What are the symptoms of autoimmune hepatitis?

The following are the most common symptoms of autoimmune hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

• Jaundice (yellowing of the skin and eyes)

• Fatigue

• Abdominal pain

• Severe acne

• Joint pain

• Joint swelling

• Cessation of menses

• Chest pain

• Diarrhea

• Fever

• Large abdomen due to large liver and spleen

• Spider-like blood vessels in the skin

• Dark urine

• Pale or gray-colored stools

• Ascites (fluid buildup in the abdominal cavity)

The symptoms of autoimmune hepatitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is autoimmune hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for autoimmune hepatitis may include the following:

• Specific laboratory blood tests, such as the following:

  • Liver function studies

  • Blood cell counts

  • Bleeding times

  • Electrolyte tests

  • Tests for other chemicals in the body

  • Autoimmune antibodies

• Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Magnetic resonance imaging (MRI). MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and doesn't involve exposure to radiation. Because the MRI machine is like a tunnel, some people are claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects can't be present in the MRI room, so people with pacemakers or metal clips or rods inside the body can't have this test done. All jewelry must be removed before the procedure.

• Liver biopsy. A procedure in which tissue samples from the liver are removed (with a needle or during surgery) for examination under a microscope.

What is the treatment for autoimmune hepatitis?

Specific treatment for autoimmune hepatitis will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The goal of treatment for autoimmune hepatitis is to drive the disease into remission (complete or partial absence of symptoms). This is done by taking corticosteroids and immunosuppressive medications. Remission may take six months to a year or longer to occur. If an individual develops liver failure, a liver transplant may be considered.