Diagnosis and treatment of autoimmune hepatitis

The article is expertly consulted by a Doctor of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Da Nang International General Hospital.

Autoimmune Hepatitis (AIH) is a liver disease caused by the body's immune system attacking and destroying liver cells. Scientists believe that there is a genetic factor that makes patients susceptible to these autoimmune diseases. About 70% of people with AIH are women. The disease progresses chronically and leads to cirrhosis, eventually to liver failure if not treated promptly.

The disease has a silent onset, with only a slight feeling of fatigue and malaise combined with mild jaundice over a long period of several months to several years; Only a small number (about 25%) have a presentation presenting as acute viral hepatitis. The disease is of real concern only when jaundice becomes apparent and a diagnosis is made. Dysmenorrhoea is a common and highly suggestive symptom, usually with a loss of one or two menstrual cycles and this occurs concomitantly with a severe episode of jaundice.
Nosebleeds, bleeding gums and bleeding under the skin are also common manifestations.
When examining the abdomen, it can be seen that the liver is enlarged and the left lobe is usually larger, however, it is an early stage, and in the late stage, the liver is often atrophied and has manifestations of portal hypertension such as spleen enlargement, ascites, collateral circulation.
However, it is important to pay attention to other associated manifestations:
Skin changes, allergic capillary inflammation, acne, erythema or scattered erythema. The spleen is enlarged and often accompanied by lymphadenopathy. Endocrine disorders with manifestations of acne, hirsutism and cracked skin, in men also have manifestations such as breast enlargement, autoimmune thyroiditis, thyrotoxicosis, diabetes. Ulcerative colitis may occur concurrently with or after the onset of autoimmune hepatitis. In addition, there are many other accompanying manifestations such as glomerulonephritis, pleural effusion, atelectasis, alveolar fibrosis, chronic anemia and frequent infections.

Diagnosing autoimmune hepatitis can be complicated and is usually completed after a person goes through a number of steps such as a doctor doing a physical exam of the patient, asking about medical history and current symptoms, blood test and liver biopsy. Tests used to diagnose autoimmune hepatitis include:

Blood tests . Testing a patient's blood sample for antibodies can distinguish autoimmune hepatitis from viral hepatitis and other diseases with similar symptoms. The antibody test also helps determine the exact type of autoimmune hepatitis a person has. In autoimmune hepatitis, the immune system produces one or more types of autoantibodies. The most common are antinuclear antibodies (ANA), anti-smooth muscle antibodies (SMA), and antibodies to liver and kidney platelets (LKM). Patients with autoimmune hepatitis type 1 have ANA, SMA, or both. Patients with autoimmune hepatitis type 2 have anti-LKM. Blood tests help differentiate autoimmune hepatitis from viral hepatitis B and C or a metabolic disease such as Wilson's disease.
There are two types of autoimmune hepatitis and both are rare. Type 1 is more common, usually seen in women aged 15 to 40 years, although any age or gender can get type 1 autoimmune hepatitis. Type 2 usually occurs with autoimmune hepatitis in children female from 2 to 14 years old. If you have autoimmune hepatitis, you most likely have another autoimmune disease, such as Crohn's disease, rheumatoid arthritis, lupus, or Sjogren's syndrome.
Liver biopsy . Doctors perform a liver biopsy to confirm the diagnosis, determine the extent of the disease, and the type of liver damage. During a liver biopsy, a small amount of liver tissue is removed using a thin needle inserted into the liver through a small incision in the skin. This patient sample is then sent to a laboratory for analysis.

If you don't have any symptoms of autoimmune hepatitis, your doctor may decide not to start treatment right away. Instead, the patient will have blood tests and liver biopsy to see if the patient's liver function is healthy.
Treatment usually begins when the person has symptoms or the patient's test results are getting worse. Initially, your doctor may prescribe prednisone, which is a medication that reduces inflammation. Your doctor may start with a high dose, then lower it and add azathioprine (Imuran) or 6-mercaptopurine (Purinethol), which helps to suppress your immune system.
Both drugs can have side effects. Steroids can thin your bones, add weight, and cause some eye problems. Azathioprine and 6-mercaptopurine can decrease white blood cell counts and increase your chances of getting cancer.
Sometimes doctors use the steroid budesonide instead of prednisone. Your doctor may prescribe other medications to suppress your immune system in place of azathioprine, such as mycophenolate mofetil (CellCept).
After 3 years of treatment, the autoimmune hepatitis of 80% of patients will be under control. Patients can stop treatment but must be agreed and closely monitored by the doctor. If symptoms return, the person will begin treatment again.
Patients also need to change their lifestyle to be healthier. Eat healthy foods and eat lots of fruits and vegetables, stay away from alcohol. Do not take any medications or supplements without the approval of your doctor.

Sometimes, if you have cirrhosis or liver failure, you may need a liver transplant. This is surgery to remove the diseased liver and replace it with a healthy donor liver.
Screening for liver cancer every 6 months is one of the ways to detect the disease early, even when there are no symptoms. Where to screen for liver cancer to give accurate results is a matter of concern for many people.
>> See more: Test to identify 14 autoantibodies in autoimmune liver disease - Article by Master, Doctor Tran Quynh Trang - Doctor of Biochemistry - Laboratory Department - Vinmec Times City International Hospital

Articles source references: Webmd.com, Mayoclinic.org