Autoimmune hepatitis

What is Autoimmune Hepatitis?

Autoimmune hepatitis is a progressive chronic inflammatory disease of the liver that can lead to liver cirrhosis. It mainly affects the female sex in 70% of cases. The disease can begin at any age, but is more frequent in adolescence or in the beginning of adulthood. Autoimmune hepatitis is characterized by the inflammation and destruction of hepatocytes (cells that make up the liver).

Causes of Autoimmune Hepatitis

The disease is caused by the attack of the immune system (defenses) of the patient that destroys the hepatocytes because the defenses do not recognize these cells as belonging to the organism. There is evidence to indicate that there is a probable genetic predisposition, since relatives of patients suffering from the disease can develop autoimmune hepatitis.

Autoimmune hepatitis seen under the microscope

Autoimmune Hepatitis affects the female sex in 70% of cases.
Dr. Vicente Carreño

Diagnosis of Autoimmune Hepatitis

It can be diagnosed by the analysis of liver enzymes (transaminases), whose result will be altered, in addition to a high concentration of immunoglobulins of type G (IgG), and the detection of auto-antibodies: anti-nuclear antibodies (title 1:40 or greater) and / or anti-smooth muscle, which characterize type 1 autoimmune hepatitis; and anti-microsome liver and / or kidney type 1 (anti-LKM-1) that characterize type 2 autoimmune hepatitis.

Most patients do not present symptoms although some may notice pruritus (itching), malaise, malaise or fatigue and jaundice (yellowing of the conjunctiva, eyes).

Autoimmune hepatitis can not be prevented; however, if the risk factors are known and it is diagnosed early, useful measures can be adopted (treatment, etc.).

Treatment

The treatment of chronic autoimmune hepatitis consists in the administration of immunosuppressive drugs (cortisone, budesonide, azathioprine, etc.). At the beginning of the same, high doses of cortisone are usually used and when the patient responds (normalization of transaminases and immunoglobulins) the dose is lowered to the minimum to maintain remission.

The percentage of remission in the treatment of chronic autoimmune hepatitis reaches 90%. However, cortisone can have notable side effects: obesity, high blood pressure, glucose increase, osteoporosis, etc. For this reason, try to keep the patient with a low dose of cortisone. In this sense, it is advisable to add azathioprine and ursodeoxycholic acid to the treatment, which may allow the use of a minimum dose of cortisone and even suppress it. There is a drug similar to cortisone (budesonide) that has less toxicity and a similar efficacy. This is because it is fixed directly in the cells of the liver.

The duration of treatment is variable but may last for years or indefinitely after reaching remission. To interrupt the treatment it is advisable to perform a liver biopsy to check the total disappearance of inflammation and destruction. If these treatments fail, there are other drugs that can be used: cyclosporine, tacrolimus, mycophenolate phenolate, although there is much less experience with its use. Finally, if everything fails, a liver transplant can be performed.

How aggressiveness can be predicted

When you have autoimmune hepatitis, you can know the degree of inflammation and severity of liver fibrosis by performing a liver biopsy. Liver ultrasound is also used.

References

Czaja AJ, Manns MP. Advances in the diagnosis, pathogenesis, and management of autoimmune hepatitis. Gastroenterology 2010;139:58-72.
Webb GJ, Hirschfield GM. Genetics of autoimmune liver disease: a brief summary for clinicians. Dig Dis 2014;32:e1-6.
Czaja AJ. Current and prospective pharmacotherapy for autoimmune hepatitis. Expert Opin Pharmacother 2014;15:1715-36.
Sebode M, Lohse AW. Future perspective: immunomodulatory therapy for autoimmune hepatitis. Dig Dis 2014;32:502-6.
Tanaka T, et al. Liver transplantation and autoimmune hepatitis. Intractable Rare Dis Res 2015;4:33-8.