Autoimmune Hepatitis

Enlightenment :

Autoimmune disease occurs when the body's immune system attacks liver cells causing the liver to get inflamed. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

Signs and symptoms

Autoimmune hepatitis may present as acute or chronic hepatitis or as well-established cirrhosis, although in rare cases it presents as fulminant hepatic failure.

Approximately one-third of patients present with symptoms of acute hepatitis marked by fever, hepatic tenderness, and jaundice. Some patients go on to develop signs and symptoms of the chronic liver disease, while others rapidly progress to acute liver failure, as marked by coagulopathy and jaundice.

In many patients, there will be no symptoms present. The patient will feel perfectly healthy. The condition may be detected by a routine blood test by an elevation in levels of certain enzymes that the liver makes.

Diagnosis

This is usually made by taking a careful look at the medical history, performing a physical examination and also doing a liver biopsy.

People with AIH may have other autoimmune diseases at the time of diagnosis of AIH before the diagnosis is made or after. Some of the conditions associated with autoimmune hepatitis include:

• thyroid disease (either over or under active)
• pernicious anaemia (a deficiency of vitamin B12)
• vitiligo (pale patches on the skin).

Other blood tests used in AIH include those that identify immunoglobulins and autoantibodies.These are antibodies in the blood that react with the body's own cells and include antinuclear antibodies (ANA) or smooth muscle antibodies (SMA).

A patient will also be made to undergo liver biopsy to diagnose autoimmune hepatitis and determine if cirrhosis is present. People often have cirrhosis at the time they are diagnosed with autoimmune hepatitis.

Treatment

For a long period of time, corticosteroids, either alone or in combination with azathioprine, have been the mainstays of drug therapy for patients with autoimmune hepatitis.

Relapse possible?

Yes ! Relapse occurs in 50% of patients within 6 months of treatment withdrawal and in 80% of patients within 3 years of treatment. Reinstitution of the original treatment regimen usually induces another remission; however, relapse commonly recurs after a second attempt at terminating therapy. Patients who relapse twice require indefinite therapy with either prednisone or azathioprine.

Liver transplantation

This procedure is effective for patients in whom medical therapy has failed or for those with decompensated cirrhosis caused by autoimmune hepatitis. Liver transplantation also may be used to rescue patients who present with fulminant hepatic failure secondary to autoimmune hepatitis.