By Dr Saravana.K
It occurs when the body’s immune system, which ordinarily attacks viruses, bacteria and other pathogens, instead targets the liver. This attack on your liver can lead to chronic inflammation and serious damage to liver cells. Just why the body turns against itself is unclear, but researchers think autoimmune hepatitis could be caused by an interaction between several risk factors, such as infections, medications and a genetic predisposition.
Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system. A liver transplant may be an option when autoimmune hepatitis doesn’t respond to drug treatments or when liver disease is advanced.
A history of certain infections. Autoimmune hepatitis may develop after a bacterial or viral infection
Having an autoimmune disease. People who already have an autoimmune disease may be more likely to develop autoimmune hepatitis.
Signs and symptoms of autoimmune hepatitis can range from minor to severe and may come on suddenly or develop over time. Some people have few, if any, recognised problems in the early stages of the disease, whereas others experience signs and symptoms that may include: fatigue, abdominal discomfort, joint pain, itching, yellowing of the skin and whites of the eyes (jaundice); an enlarged liver; nausea and vomiting; and loss of appetite.
Autoimmune hepatitis that goes untreated can cause permanent scarring of the liver tissue (cirrhosis). Complications of cirrhosis include: fluid in your abdomen (ascites); liver failure; liver cancer. People with cirrhosis have an increased risk of liver cancer.
Tests and procedures used to diagnose autoimmune hepatitis include: blood tests and liver biopsy. The goal of treatment is to slow or stop your body’s immune system from attacking your liver. This may help slow the progression of the disease.
Medications used to treat autoimmune hepatitis include:
Prednisolone. An initial high dose is used, the medication is reduced to the lowest possible dose that controls the disease over a few weeks. Most people need to continue taking the prednisone for at least 18 to 24 months, and some people remain on it for life. Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued.
Prednisolone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, thinning bones (osteoporosis), high blood pressure, cataracts, glaucoma and weight gain.
Azathioprine. An immunosuppressant is sometimes used along with prednisolone. Using both medications may allow you to take a smaller dose of prednisolone, reducing its side effects. Side effects of azathioprine may include difficulty fighting infections and nausea. Rare side effects include liver damage, pancreas inflammation (pancreatitis) and cancer.
Other immunosuppressants. If you don’t respond to prednisolone or azathioprine, your doctor may prescribe stronger immunosuppressants, such as mycophenolate, cyclosporine or tacrolimus.
When medications don’t halt the progress of the disease, or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.