Autoimmune Hepatitis
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Autoimmune hepatitis is a condition in which the body’s immune system attacks the liver, causing inflammation and damage. If untreated, it can progress to severe liver disease or liver failure, so early diagnosis and treatment are essential.
Common symptoms include:
- Fatigue and weakness
- Abdominal pain
- Joint pain
- Jaundice (yellowing of skin and eyes)
- Itching
- Menstrual irregularities or absence of menstruation
Diagnosis
- Diagnosis involves a combination of clinical evaluation and investigations:
- Medical history & physical examination
- Blood tests:
- Liver enzymes (SGOT/SGPT) – usually elevated
- Autoimmune markers (ANA, ASMA, AMA)
- Liver biopsy:
- Confirms diagnosis
- Assesses inflammation and severity
- Imaging tests:
- Ultrasound / CT scan
- FibroScan (to assess liver scarring)
Treatment & Management
Treatment focuses on suppressing the immune system to reduce inflammation and prevent liver damage.
- 1. Steroids
- Prednisone / Prednisolone (first-line treatment)
- Budesonide (in selected patients)
- Possible side effects:
- Weight gain
- Acne
- Mood and sleep changes
- Diabetes
- Weak bones (osteoporosis)
- High blood pressure
- Increased infection risk
- Doctors use the lowest effective dose and monitor regularly.
- 2. Immunosuppressants
- Azathioprine
- 6-mercaptopurine
- Benefits:
- Reduce steroid requirement
- 6-Help maintain long-term disease control
- Possible side effects:
- Low white blood cell count
- Nausea
- Pancreatitis
- Abnormal liver tests
- Regular blood monitoring is essential.
Duration of Treatment
- Treatment continues until the disease goes into remission
- Remission means:
- No symptoms
- Normal or near-normal blood tests
- Improvement on liver biopsy
- Most patients achieve remission within 2–3 years
- However:
- 75–80% may relapse after stopping treatment
- Some patients may require long-term or lifelong therapy
Complications
- If untreated or poorly controlled, autoimmune hepatitis can lead to:
- Cirrhosis: Permanent liver scarring
- Liver failure: Severe loss of liver function
- Liver cancer
Conditions
- Diagnosis is based on:
- Patients with autoimmune hepatitis may also have other autoimmune diseases, such as:
- Celiac disease
- Rheumatoid arthritis
- Type 1 diabetes
- Thyroid disorders
- Screening for associated conditions is important for comprehensive care.
Importance of Follow-Up
- Helps track treatment response
- Allows dose adjustments
- Detects side effects early
When is Liver Transplant Needed?
- Liver transplantation may be required in:
- Advanced cirrhosis
- Liver failure
- Cases not responding to medical treatment
FAQ's
What is autoimmune hepatitis?
A condition where the immune system attacks liver cells, causing inflammation and liver damage.
Symptoms?
Fatigue, jaundice, abdominal discomfort, joint pain, enlarged liver
Diagnosis?
Blood tests (autoantibodies), liver function tests, liver biopsy
Treatment?
Immunosuppressive medications (steroids, azathioprine), regular monitoring
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