Autoimmune Hepatitis

When your body's immune system begins to attack liver cells, you get autoimmune hepatitis, which is liver inflammation. Although the precise origin of autoimmune hepatitis is unknown, it appears that environmental and genetic variables work together over time to develop the illness.

Untreated autoimmune hepatitis can cause cirrhosis, which is the scarring of the liver, and finally liver failure. However, autoimmune hepatitis may frequently be managed with immune-suppressing medications when it is identified and treated early.

When autoimmune hepatitis does not improve with medication or in situations of severe liver disease, a liver transplant may be a possibility.

Autoimmune Hepatitis: Causes

When the immune system of the body, which typically fights off viruses, bacteria, and other pathogens, instead assaults the liver, autoimmune hepatitis develops. This assault on your liver may result in long-lasting inflammation and severe liver cell damage.

Researchers believe that autoimmune hepatitis may be brought on by the combination of genes that affect immune system activity and exposure to specific viruses or medicines. The exact reason the body turns against itself is unknown.

Autoimmune Hepatitis Types

There are two basic types of autoimmune hepatitis, according to doctors.

  • Hepatitis type1 autoimmune. The disease's most prevalent form is this one. At any age, it may happen. About half of those who have type1 autoimmune hepatitis also have ulcerative colitis, rheumatoid arthritis, or celiac disease.

  • Hepatitis type2 autoimmune. Type2 autoimmune hepatitis can occur in adults, however, it more frequently affects children and adolescents. This kind of autoimmune hepatitis may also be accompanied by other autoimmune disorders.

Autoimmune Hepatitis: Symptoms

Autoimmune hepatitis symptoms can appear rapidly and differ from person to person. In the early stages of the condition, some persons have few, if any, noticeable issues while others show signs and symptoms like −

  • Fatigue

  • Uncomfortable stomach

  • Whites of the eyes and skin become yellow (jaundice)

  • A swollen liver

  • Irrational skin blood vessels (spider angiomas)

  • A skin rash

  • Joint aches

  • Reduction in menstrual cycles

Autoimmune Hepatitis: Complications

Untreated autoimmune hepatitis can result in hepatic tissue damage that is irreversible (cirrhosis). Cirrhosis complications include −

  • Esophageal veins that are enlarged (esophageal varices). Blood may back up into other blood arteries, primarily those in your stomach and esophagus when the portal vein's blood flow is obstructed. The blood arteries have weak walls and are liable to bleed because they are carrying more blood than they were designed to. Massive bleeding from these blood vessels in the esophagus or stomach is a serious emergency that has to be treated right once.

  • You have abdominal fluid (ascites). Your abdomen may fill up with a lot of fluid if you have liver illness. Ascites is typically a symptom of severe cirrhosis and can be painful and sometimes disruptive to breathing.

  • Liver dysfunction This happens when severe liver cell damage renders your liver incapable of performing as it should. Currently, a liver transplant is required.

  • Liver disease. Cirrhosis patients are more likely to develop liver cancer.

Autoimmune Hepatitis: Risk Factors

The major risk factors include −

  • Being a woman. Although autoimmune hepatitis can affect both sexes, it affects women more frequently.

  • A background of certain illnesses. Herpes simplex, the Epstein-Barr virus, or measles can all cause autoimmunity hepatitis. Hepatitis A, B, or C infection is also a factor in the condition.

  • Heredity. According to available data, autoimmune hepatitis may run in families.

  • Enduring an autoimmune condition. A person may be more susceptible to developing autoimmune hepatitis if they already have an autoimmune condition, such as celiac disease, rheumatoid arthritis, or hyperthyroidism (Graves disease or Hashimoto's thyroiditis).

Autoimmune Hepatitis: Diagnosis

The following tests and techniques are used to identify autoimmune hepatitis −

  • A blood test. Antibody testing on a sample of your blood helps distinguish between viral and other illnesses with similar symptoms and autoimmune hepatitis. Determine the specific form of autoimmune hepatitis you have with the use of antibody testing.

  • A liver biopsy to confirm the diagnosis and ascertain the kind and extent of liver injury, doctors perform a liver biopsy. During the treatment, a tiny incision in your skin is used to insert a thin needle into your liver and remove a little quantity of liver tissue. The sample is subsequently delivered to a lab for evaluation.

Autoimmune Hepatitis: Treatment

The aim of treatment, regardless of the kind of autoimmune hepatitis you have, is to reduce or stop the immune system's attack on your liver. This could delay the disease's development. You'll need medicines that reduce immune system activity to achieve this aim. Prednisone is typically the first course of therapy. Prednisone may be advised in conjunction with azathioprine (Azasan, Imuran), another drug.

Prednisone, particularly when taken for an extended period, can have several dangerous adverse effects, such as diabetes, osteoporosis, osteonecrosis, high blood pressure, cataracts, glaucoma, and weight gain.

Prednisone is often prescribed by doctors for the first month or so of therapy at a high dosage. Then, over the following several months, they progressively lower the dose to lessen the chance of adverse effects, until they achieve the lowest level that can still control the condition. You can also prevent the negative effects of prednisone by taking azathioprine.

Even though you could go into remission a few years after beginning therapy, the disease frequently comes back if the medication is stopped. Depending on your circumstances, you could need ongoing care.

An Organ Transplant

The only remaining alternative is a liver transplant when treatments are unable to stop the progression of the illness, you experience permanent scarring (cirrhosis), liver failure, or both.

A healthy liver from a donor is substituted for your damaged liver during a liver transplant. Most frequently, dead organ donors' livers are used in liver transplants. Liver transplants from living donors may be used in specific circumstances. You only get a piece of a healthy liver from a living donor when you undergo a living donor liver transplant. Both livers almost instantly start producing new cells.

Autoimmune Hepatitis: Prevention

A majority of the time, autoimmune hepatitis cannot be stopped. Knowing the risk factors might aid in early illness detection and treatment.

One in every 100,000 persons has autoimmune hepatitis. Women are often diagnosed with the condition in their 40s or 50s, and they are more likely than males to get it. Girls between the ages of two and 14 may also get the illness.

Autoimmune hepatitis is also more likely to occur in those who have diabetes, rheumatoid arthritis, thyroid problems, or celiac disease (just as those with autoimmune hepatitis are also at higher risk to develop other autoimmune diseases). A person is more likely to get the illness if they have a family history of autoimmune hepatitis.


The cause of the ongoing liver inflammation known as autoimmune hepatitis is uncertain. Corticosteroids are usually effective for patients. Prednisone and azathioprine are the two medications most frequently utilized in treatment plans.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha