Autoimmune Hepatitis

Autoimmune hepatitis is treated by our GI Division at Premier Medical Group. Autoimmune hepatitis is a disease in which the body’s immune system attacks normal cells in the liver. This causes inflammation of the liver, also referred to as hepatitis. Some studies reason that a genetic factor can make some people more susceptible to autoimmune diseases. About 70% of those with autoimmune hepatitis are female.

Autoimmune hepatitis is a serious and chronic disease, and if not treated, will progress and worsen over time. It can last for years, and even lead to cirrhosis (scarring and hardening of the liver). Ultimately, liver failure can result.

What is autoimmune disease?

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The immune system has an important job: it protects our body from viruses, bacteria, and other living organisms. Sometimes, the immune system attacks and destroys its own healthy body tissue; this is called autoimmunity. There are more than 80 different types of autoimmune disorders.

What causes autoimmune hepatitis?

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The exact cause of autoimmune hepatitis is unknown, but it is believed to be linked to a combination of genetic and environmental factors. Research has found that certain genes that are known to play a role in the immune system are associated with a tendency to develop autoimmune hepatitis. Examples of environmental factors are viruses, bacteria, drugs, and toxins. Scientists are working to better understand these causes. With an autoimmune disease, the immune system can’t tell the difference between healthy body tissue and harmful, outside substances, resulting in an immune response that destroys normal body tissues.

What are the symptoms of autoimmune hepatitis?

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The most common symptom of autoimmune hepatitis is fatigue. Other symptoms may include:

  • Fever
  • Abdominal pain
  • Arthritis
  • Anemia
  • Dry eyes and mouth
  • Recurrent jaundice frequently develops in severe cases
  • Lack of menstrual periods

Normally, these symptoms of autoimmune disease develop gradually over the course of weeks or months. Symptoms also vary, depending on the type of the disease and the location of the abnormal immune response.

How is autoimmune hepatitis diagnosed?

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The most common methods to diagnose autoimmune hepatitis or autoimmune disease are based on symptoms, blood tests, and a liver biopsy.

A routine blood test to check for liver enzymes can help reveal a pattern typical of hepatitis. To diagnose autoimmune hepatitis, your doctor will need to order additional blood work to test for autoantibodies, which attack the body’s cells. With autoimmune hepatitis, the immune system may produce one or more types of “autoantibodies”: antinuclear antibodies (ANA) (link), smooth muscle antibodies (SMA) (link), and antibodies to liver and microsomes (anti-LKM) (link). Those with Type 1 have ANA, SMA, or both, and those with Type 2 have anti-LKM. A blood test will help to differentiate autoimmune hepatitis from other diseases that resemble it, such as viral hepatitis B (link) or C (link) or a metabolic disease such as Wilson disease.

A liver biopsy can help your doctor correctly diagnose autoimmune disease and measure the severity. The procedure is done in a hospital under anesthesia. A small sample of liver tissue is removed with a needle and examined under a microscope.

What are the types of autoimmune hepatitis?

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There are two types of autoimmune hepatitis: Type 1 and Type 2.

The most common form of autoimmune hepatitis in North America is Type 1. Although it can occur at any age, this type affects adolescents and young adults. About 50% of those with Type 1 also have other autoimmune disorders, such as:

  • Thyroiditis (inflammation of the thyroid)
  • Ulcerative colitis
  • Graves’ disease
  • Type 1 diabetes
  • Ulcerative colitis
  • Sjögren’s syndrome, which causes dry eyes and mouth autoimmune anemia
  • Inflammation of blood vessels in the kidneys
  • Inflammation of the thyroid gland

The second type of autoimmune hepatitis is Type 2. This is less common and typically affects girls aged 2 to 14, although adults can have it too.

How is autoimmune hepatitis treated?

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The main course of treatment for autoimmune hepatitis is medicine to suppress, or slow down, an overactive immune system. When diagnosed early and with proper treatment autoimmune hepatitis can frequently be controlled. Studies show that continuous response to treatment has proven to stop the disease from getting worse and to feasibly reverse some of the damage.

The medicine of choice is a daily dose of a corticosteroid called prednisone. Treatment may begin with a higher dose and be tapered as the disease is controlled. The objective is to find the lowest possible dose that will control the disease.

Your doctor may consider using another medicine called azathioprine (Imuran), which also suppresses the immune system, but in a different way. Treatment may begin with both azathioprine and prednisone, or azathioprine may be added later, once the disease is under control. The use of azathioprine permits for a lower dose of prednisone, which in turn results in the reduction of prednisone’s side effects. Treatment with prednisone and azathioprine can last for years, even for the lifetime of the patient. Some patients, who have a low form of the disease, may not need to take any medications. Each case is evaluated to decide the best course of treatment.

Frequently Asked Questions about Autoimmune Hepatitis

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Are there side effects to prednisone and azathioprine?

Yes, they both have side effects. Most commonly weight gain, thinning of bones, (osteoporosis), anxiety, high blood pressure, cataracts, and glaucoma. Azathioprine can also lower white blood cell counts and sometimes causes nausea and poor appetite.

Rare side effects can include allergic reaction, liver damage, and pancreatitis.

Are other treatments for autoimmune hepatitis available?

Some patients do not respond well to standard therapy. Other immunosuppressive agents such as mycophenylate mofetil, cyclosporine, or tacrolimus may be used. Still others who develop into liver failure (cirrhosis) may need a liver transplant.

How does HCV (hepatitis C-virus) Trigger Autoimmune Conditions?

The progression is not thoroughly understood. Research conjectures that proteins appear on the surface of infected liver cells and this leads to an autoimmune response. The cells in the immune system identify these new proteins as foreign bodies, and attack the liver, causing inflammation of the liver cells and ultimate damage of liver tissue.

What can I expect with autoimmune hepatitis?

Each outcome is different, depending on the severity of the disease. Most autoimmune diseases are chronic, but many can be controlled with treatment. The symptoms of autoimmune disorders can come and go.

Who is more at risk for autoimmune hepatitis?

Women are at a higher risk than men, and Type 2 typically affects young girls. Genetics can play a part in a predisposition to the disease.