The acute or chronic inflammatory autoimmune disease of the liver
Autoimmune hepatitis is an acute or chronic inflammation of the liver. The inflammation is not caused by a pathogen, rather the body’s own immune system attacks the liver.
Who is affected by autoimmune hepatitis?
Four times more women than men are affected. The disease usually appears in young adulthood. 10 to 20 percent of chronic liver diseases are caused by autoimmune hepatitis. There is an association with other autoimmune diseases.
What are the causes?
The origin of the disease is unclear. Toxic substances from the environment and viruses are under discussion as triggers. Since the latter are not or no longer detectable when the disease breaks out, they can only be considered as triggers. They are not involved in the disease itself. There is probably a genetic predisposition to autoimmune hepatitis. This means that the disease occurs more frequently with certain genetic predispositions
Which autoimmune hepatitis symptoms are typical?
Patients with autoimmune hepatitis usually have few symptoms. These begin insidiously and unspecifically with exhaustion, tiredness, loss of appetite, upper abdominal pain and reduced performance.
Autoimmune hepatitis is even more normal in older patients than in younger patients. The usual symptoms of liver cirrhosis only occur in the case of more pronounced liver damage, when the liver is remodeled with connective tissue. These symptoms include weight loss and jaundice. Jaundice occurs when the liver does not convert enough bilirubin into a degradable form for the body to eliminate. The jaundice is noticeable by a yellow discoloration of the skin.
How is autoimmune hepatitis diagnosed?
First, the liver values are increased in autoimmune hepatitis. The so-called transaminases that can be detected in the blood stand for the liver damage that has occurred. The blood test reveals increased inflammatory values as an expression of the inflammatory processes in the liver. The body increasingly produces antibodies of the IgG type. It produces them when the body creates a chronic inflammatory response.
In order to find out whether a virus is to blame for the hepatitis (viral hepatitis) or whether autoimmune processes have caused it, the doctor first tests for special autoantibodies. Examples of such autoantibodies are ANA (antinuclear antibodies), SMA (smooth muscle antibodies) or LKM1 (Liver Kidney microsomes).
These autoantibodies are found in various other autoimmune diseases. Since the autoantibodies can also be detected in rare cases of viral hepatitis, a negative virus serology is also carried out to rule out viral development. With the help of a biopsy, a doctor detects microscopically typical changes in the tissue.
How is autoimmune hepatitis treated?
The doctor prescribes glucocorticoids and azathioprine as the drugs of choice. Both drugs suppress the body’s immune system. Since this causes damage to the liver, suppressing it can prevent the damage. This averts the destruction of the liver. Lifelong immunosuppression is usually necessary. If the disease causes massive damage, the last possible measure is a liver transplant. In 40 percent of cases, autoimmune hepatitis recurs in the transplanted liver.
What autoimmune diseases are associated with autoimmune hepatitis?
Autoimmune hepatitis is often associated with an autoimmune reaction against thyroid tissue, vessels, colon, pleura or skin.
What sub-forms are there?
There are two types of autoimmune hepatitis. Type I is the most common form (80 percent) in which the autoantibodies ANA and SMA are the most common. The prognosis of this form of autoimmune hepatitis is better than that of the second type – even if 40 to 45 percent of those affected develop cirrhosis of the liver. Type II occurs mainly in children and is more severe than type I. The symptoms are more pronounced and the disease often ends with cirrhosis of the liver. Type II is characterized by the autoantibodies of the LKM1 type.
What complications are possible?
The most important complication of autoimmune hepatitis is liver cirrhosis. As the disease progresses, this connective tissue remodeling of the liver leads to liver failure, which is fatal without transplantation.
What’s the prognosis?
Autoimmune hepatitis requires urgent treatment, otherwise it will be fatal. With appropriate therapy, the prognosis is good if there is a response. These patients have an almost normal life expectancy. If cirrhosis of the liver occurs or if the medication is ineffective, the prognosis is worse, depending on the severity of the disease.
Medical note for our readers:
Our patient information explains medical topics in a simple and understandable way. Our information is not a substitute for a medical examination. Please see a specialist for diagnosis or treatment.
