Autoimmune Hepatitis (AIH)

What is autoimmune hepatitis?

Autoimmune hepatitis (AIH) is inflammation of the liver that occurs when the body’s immune system turns against the liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and environmental factors appear to interact over time to trigger the disease. 

What are the types of autoimmune hepatitis? 

The two main forms of autoimmune hepatitis are as follows:

• Type 1 autoimmune hepatitis: 

The most common type of autoimmune hepatitis disease is Type 1. Age isn’t a barrier to it. It can generally occur at any age. Half the people with type 1 disease usually have other autoimmune disorders like celiac disease, rheumatoid arthritis, or else ulcerative colitis. It is characterized by the presence of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA).

• Type 2 autoimmune hepatitis:

It is the most common type of autoimmune hepatitis in children and young people, though adults can also develop type 2 autoimmune hepatitis. Certain other autoimmune diseases can also accompany this type of autoimmune hepatitis disease. It is characterized by the presence of anti-liver kidney microsomal antibody type 1 (anti- LKM1) and anti-liver cytosol type 1 (anti-LC1) autoantibodies.

Causes

Though doctors are unsure on what causes autoimmune hepatitis disease in people, a few of the causes that are thought to cause AIH are as follows possibly:

• Autoimmune hepatitis can usually run- in families and can be passed on to the other member of the family by genes
• Medicines like statins as well as hydralazine that is used to treat heart problems can cause autoimmune hepatitis
• Antibiotics such as nitrofurantoin as well as minocycline cause AIH
• Stress is also another factor
• Infections like viral hepatitis, measles, herpes and also Epstein-Barr virus.

What are the risk factors for autoimmune hepatitis?

A few of the associated risk factors that can increase AIH or autoimmune hepatitis are as follows:

• Being female
• Infections related history
• Hereditary
• Having autoimmune disease

Symptoms

Symptoms of autoimmune hepatitis, in fact, differ from person to person. It may occur suddenly. In most of the cases, people have few symptoms. Some of the signs of autoimmune hepatitis are as follows:

• Fatigue
• Abdominal discomfort
• Enlarged liver
• Jaundice
• Spider angiomas or abnormal blood vessels in the skin 
• Skin rashes or acne
• Joint pain or muscle pain
• Vomiting and nausea
• Gallstones
• Hepatic encephalopathy or brain issues

How is autoimmune hepatitis diagnosed and treated?

Autoimmune hepatitis disease usually involves the following diagnosis and treatment procedures: 

Diagnosis of autoimmune hepatitis:

• Physical examination- During the physical examination, the doctor will examine the patient thoroughly to look for any signs of abnormalities.
• Medical and hereditary history- The doctor will record the medical history of the patient, regarding their medication history or history of undergoing any surgeries and history of autoimmune hepatitis for any family members.
• Laboratory investigations- They include a complete blood count, a coagulation panel (to check how the clotting factors work), a liver function test, an electrolyte panel, and autoimmune antibodies. 

• Imaging scans- They include CT scans of the abdomen, MRI scans, and ultrasonography. These scans help us to identify any kind of abnormalities in the liver.
• Liver biopsy– During this procedure, a small tissue sample is taken from the liver and sent for histopathological studies. 

During the Treatment:

• Steroid – The doctor will prescribe the patient prednisone which is a steroid that can ease inflammation. 
• Immunosuppressant drugs – The patient will be started off on autoimmune hepatitis medication with a high dose. Then the doctor will lower it with azathioprine or Imuran or with 6-mercaptopurine, which is otherwise called Purinethol, to weaken the immune system.
• Sometimes, the doctor will advise the patient to take prednisone or mycophenolate mofetil to weaken the immune system.
• Liver transplantation – Liver transplant is suggested in patients with very severe autoimmune hepatitis conditions. 

Autoimmune Hepatitis Prognosis, Post Treatment, and Recovery:

• After almost 3 years of treatment, in most cases, about 80% of people feel recovered and find that their condition is under control. 
• Many people can also stop their treatment. However, the doctor still keeps an eye on the patient’s health since the signs and symptoms can come back, then in such cases, the patient will be asked to start treatment again.
• Autoimmune hepatitis cirrhosis or liver failure would require the transplantation of liver surgery in the future. This will help to replace the damaged liver with a healthy one from the donor.

Autoimmune Hepatitis Diet

• Lifestyle changes, as well as eating a balanced diet with plenty of vegetables and fruits, will be asked by the doctor to be done.
• A mix of whole grains, nuts, lean meats, as well as fish works best for most people who want to meet nutritional needs, thus helping them to maintain a healthy weight. 
• A diet that is high in fiber, in particular, can also help the liver function to be run at an optimal level.

What are the complications associated with autoimmune hepatitis?

A few of the associated complications that can complicate AIH or autoimmune hepatitis are as follows:

• Enlarged veins in the esophagus (esophageal varices)
• Ascites or fluid in the abdomen
• Liver failure
• Liver cancer
• Confusion
• Itching, bruising
• Liver cirrhosis 

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