Autoimmune hepatitis is a rare disease of the liver. As the disease progresses, the body develops antibodies that damage its own liver. If left untreated, the patient may die.
What is autoimmune hepatitis?
Autoimmune hepatitis is not caused by viruses. Instead, a misregulation occurs that causes the body to no longer consider certain cells as the body’s own tissue. The process results in liver inflammation with a chronic course. About 80 percent of patients are women. Cases of the disease occur particularly frequently in middle age. However, its development in children cannot be ruled out either. While autoimmune hepatitis used to be one of the most common diseases, the incidence today is 0.2 to 1.0 per 100,000 inhabitants. In addition to specific symptoms, there are also those that are rather less typical of liver disease.
Causes
The exact causes of autoimmune hepatitis are not fully understood to date. Ultimately, the body no longer accepts liver tissue as its own cells. As with any occurrence of foreign bodies, it produces antibodies to fight the supposed pests. In this way, the organism normally wants to protect itself from invaders and pathogens. However, the destruction of healthy tissue leads to chronic inflammation, which in the long term is accompanied by a loss of function of the organ. However, it is not yet known why the dysregulation of the immune system occurs. Scientists assume that some patients have a genetic predisposition. In addition to this basic predisposition, factors are believed to exist that are responsible for the onset of the disease. These include, for example, pregnancy, infections or exposure to toxins. Further in the suspicion are certain medicines, toxins and infections by viruses or bacteria.
Symptoms, complaints and signs
For the most part, the symptoms of autoimmune hepatitis are considered uncharacteristic. There are manifestations such as fatigue, decreased performance, nausea, or a slight discoloration of the skin that takes on a yellow hue. Some patients complain of pain in the right upper abdomen or temperature increases. However, these often cannot be attributed to any physical manifestations, which is why autoimmune hepatitis is not infrequently diagnosed relatively late. In some patients, there are generally no complaints or symptoms at all. Instead, the disease only becomes noticeable as it progresses. Approximately 30 to 50 percent of those affected also have other diseases that are related to the misregulation of the immune system. Thus, other organs are attacked by the body, and inflammations of the colon, thyroid gland or rheumatoid arthritis occur. In some cases, autoimmune hepatitis rapidly develops into liver failure. Thus, subsequent treatment must address not only the primary autoimmune hepatitis but also the diseases that have developed from it.
Diagnosis and course
The time at which the diagnosis is made is responsible for the further course of the disease. If left untreated, the occurrence of liver cirrhosis cannot be ruled out. Laboratory tests of the blood are the main tests used to establish the diagnosis. In this there are indications of a possible infection by viruses as well as the level of antibodies. Once autoimmune hepatitis is suspected, it is verified or falsified by taking a tissue sample of the liver. The procedure takes place under local anesthesia. The tissue can then be examined in the laboratory. If the disease is detected and treated at an early stage, various therapeutic approaches exist to which the body usually responds well. However, if left untreated, the chances of cure are low.
Complications
Autoimmune hepatitis can progressively destroy the liver, resulting in liver failure (hepatic insufficiency). Liver failure is initially characterized by decreased synthesis efficiency. As a result, fewer clotting proteins are produced, so bleeding time is prolonged. This can lead to bleeding, especially in the gastrointestinal tract. There is also the formation of edema and an accumulation of water in the abdominal area, ascites. In addition, sugar production is disturbed so that the body becomes hypoglycemic, which can end in a coma.In addition, the liver can no longer properly detoxify toxins that accumulate in the body, especially the neurotoxin ammonia. The ammonia can cross the blood–brain barrier and lead to a hepatic encephalopathy, which can also end in a coma and, in the worst case, in the death of the patient. In addition, autoimmune hepatitis can develop into scarring of the liver tissue, liver cirrhosis, which presents similar complications. Due to liver cirrhosis, collateral circulation is formed, and the affected person develops hemorrhoids and varicose veins of the stomach and esophagus. In addition, there is increased depletion of blood in the spleen, causing it to enlarge and providing corresponding pain. As a result of hepatorenal or hepatopulmonary syndrome, the kidneys or lungs may fail due to cirrhosis of the liver. The likelihood of developing liver cancer in the course is also increased.
When should you see a doctor?
With autoimmune hepatitis, it is almost essential to have regular checkups and to undergo close medical evaluations of the liver’s condition. Autoimmune hepatitis damages the liver. Therefore, it is necessary to determine the effectiveness of the medication used and whether it is necessary to initiate other or additional treatment measures. If symptoms occur between check-ups, patients should not be shy and contact the doctor before the next routine check-up. These specific complaints include, for example, upper abdominal pain, colicky pain, dark urine associated with light-colored stools, and effects of jaundice in the form of discoloration of the skin and/or eye. Severe courses and effects of the autoimmune disease necessitate more frequent visits to the doctor at shorter intervals. Control examinations should be closely followed by patients in any case, since the disease can also have relapsing phases, which are then detected in time.
Treatment and therapy
Therapy consists of either treatment with cortisone or the administration of immunosuppressants. In some patients, a combination of the drugs is used. There is no gentler method of treating the symptoms, for example, using alternative healing methods. Immunosuppressants ensure that the immune system is suppressed. An increased dose of immunosuppressive usually allows a reduction of cortisone. Usually, the medication is set very high at the beginning and then reduced regularly until the patient reaches his or her individually appropriate dose. Particularly in women of childbearing potential, treatment with cortisone alone is often initially sought. However, cortisone has a relatively high number of side effects. For example, it can cause acne, full moon face, stomach ulcers, osteoporosis and high blood pressure. Many of the side effects develop primarily because of the long duration of use. Therapy with cortisone should continue for at least two years if autoimmune hepatitis is present. Only after this time is it recommended to attempt reduction or discontinuation of the medication under medical supervision. Regular medical check-ups are inevitable here. Optimal drug treatment can ensure that autoimmune hepatitis is quiescent and no longer active. In this way, it is possible for patients to achieve a normal life expectancy with the disease. However, if cirrhosis of the liver has already developed due to autoimmune hepatitis, transplantation with a donor organ is often the only option. Transplantation may lead to further complications and worsen the prognosis. That is why prompt action is required when the diagnosis is recognized.
Outlook and prognosis
Factors that significantly increase the risk of an unfavorable course of autoimmune hepatitis include late diagnosis, delayed treatment, and high inflammatory activity. Unfortunately, the prognosis for a child or adolescent organism usually looks bleaker, which is due to higher activity of the young immune system. However, the fight is worth it. Only a few decades ago, about 90 percent of those affected died within 10 years. The introduction of immunosuppressants into clinical practice has reversed the statistics: now survivors make up the 90 percent. Autoimmune hepatitis can be monitored using biochemical and histological controls.The formation of bridging necrosis should be resisted, as its encroachment on hepatic veins is highly risky. If liver cirrhosis is avoided, the patient is also protected against the development of hepatocellular carcinoma. Thanks to immunosuppressive therapy, liver cirrhosis occurs much less frequently and the course of the disease improves in half of those affected. Liver transplantation can be compared to drug therapy – it guarantees a good prognosis for at least five years in more than 90 percent of cases. Unfortunately, autoimmune hepatitis allows only secondary prophylaxis by antibody and immunoglobulin control. Patients should take it easy physically and emotionally, follow a light diet, and reduce medication to the bare minimum.
Prevention
Because the exact causes leading to the development of autoimmune hepatitis are not yet known, preventive treatment is not possible. A healthy lifestyle with plenty of exercise, a sensible diet, and restriction of nicotine and alcohol may prove beneficial in some circumstances, but it also cannot prevent autoimmune hepatitis.
Follow-up
There is no causal cure for autoimmune hepatitis. Therefore, follow-up care cannot aim to prevent recurrence of the disease. Instead, the goal is to keep daily life symptom-free and prevent complications. Patients attend regular follow-up examinations. The disease can be diagnosed by blood tests. To keep an eye on the extent and structure of the liver, an ultrasound examination often follows. Patients are responsible for ensuring that their condition does not worsen. The prescribed immunosuppressants must be taken regularly. In addition, there are opportunities in everyday life to take care of the liver. Patients should avoid alcohol and reduce excess weight in the long term. In addition, sufficient physical exercise is necessary. It is possible to be vaccinated against certain forms of hepatitis. However, this preventive measure is not available for the autoimmune disease. The success of the protracted treatment depends on the starting time. The earlier patients start therapy, the more symptom-free their lives will be. If complications occur, life is automatically greatly reduced. Negative consequences include remodeling of the liver and limitations in detoxification function. With the consistent progression of symptoms, hospitalization becomes necessary.
Here’s what you can do yourself
In the case of autoimmune hepatitis, a healthy lifestyle is of great importance in addition to medical treatment. This is because it can both improve the condition and prevent impending deficiency symptoms. Patients should eat a balanced and healthy diet and exercise regularly. In addition, it is important to reduce any existing excess weight and to prevent underweight. A vegan lifestyle also helps to improve transaminases (liver values) in autoimmune hepatitis. Those suffering from autoimmune hepatitis should also avoid substances that are harmful to the liver – especially alcohol. In contrast, studies from recent years suggest that coffee protects the liver. This is because, as research findings have shown, coffee helps to prevent liver cancer in chronically ill liver patients. While taking a cortisone preparation, such as prednisolone, patients should take vitamin D and calcium. These prevent cortisone-induced bone loss. To protect the liver and achieve regeneration, herbal preparations, including milk thistle, licorice, artichoke, schizandrin C (DDB), or homeopathic agents, such as liver organ extracts, are also used. In addition, supplementary amino acids and vital substances strengthen the affected organ. Fasting can also have a positive effect on autoimmune hepatitis. However, this should not be done if cirrhosis of the liver is already present. As a general rule, complementary therapies, whether naturopathic or homeopathic, should always be discussed with the attending physician and should be carried out under supervision.
