Autoimmune hepatitis is a disease that occurs because the patient’s defenses attack the liver, which causes inflammation and destruction and if left untreated, can lead to liver cirrhosis and liver cancer. Years ago it was a very rare disease but now this is changing. Thus, in the year 2000, approximately 11 out of every 100,000 people suffered this disease but currently it has increased to 25 out of every 100,000. There are three forms of presentation with the following frequency: 27% acute, 30% chronic and 43% asymptomatic. In the acute form common symptoms are: fatigue, lack of appetite, jaundice (yellow coloration of the conjunctiva and skin), etc. However, in the other two forms of autoimmune hepatitis there are usually no symptoms although clinical analyses are altered.
In 90% of autoimmune hepatitis the diagnosis can be established by analysis: patients can be positive to autoantibodies or present elevated immunoglobulins levels. However, the biggest diagnostic problem is that 10% of cases result negative to these tests. In these patients, the diagnosis is established excluding other causes of liver disease (A, B, C, D and E viruses, drug hepatotoxicity, Wilson’s disease, etc.). The experience of the doctor who takes care of the patient is very important to establish the diagnosis and it is convenient to confirm it by performing a liver biopsy.
Treatment of autoimmune hepatitis
Treatment of autoimmune hepatitis consists in the administration of cortisone alone or in combination with another drug (azathioprine). However, cortisone can often cause side effects (weight gain, high blood pressure, diabetes, etc).
To avoid this toxicity, in our clinic, instead of using classic cortisone, we start the treatment with budesonide (a modern form of cortisone that goes directly to the liver and thus the possibility of toxicity is much lower).
Finally, it is important to emphasize that autoimmune hepatitis does not have to be a disease of indefinite duration since after a few years of treatment this can be suspended with the possibility of a definitive cure.