The Basics of Autoimmune Hepatitis and How to Manage it

Autoimmune diseases are undoubtedly the most devastating conditions affecting people all across the world. With a high resistance to diagnosis and treatment, such conditions can force you to think that your body hates you.

Amidst the hundreds of autoimmune diseases currently recognized, autoimmune hepatitis is considered a rare one. It is when your immune system mistakenly starts attacking the liver cells. Like other autoimmune issues, experts do not know what exactly triggers this disease in up to 200,000 people in the United States. Nevertheless, it is important to educate yourself about it, especially if you or a loved one is suffering from it.

This article sheds light on autoimmune hepatitis, its symptoms, diagnosis, and how to manage it.

An Overview of Autoimmune Hepatitis 

The liver refers to an accessory digestive organ present on the right side of your abdomen, just under the ribs. Some of its key functions include filtering the waste particles from the body, storing sugar to use for energy, and synthesizing digestive bile juices to break down and absorb food. Autoimmune hepatitis occurs when the body’s immune cells start attacking the liver tissue to the point of complete destruction and necrosis.

The immune system comprises different types of blood cells, such as macrophages and neutrophils. All these cells have one common goal; to protect the body from any danger and destroy all external invaders that may pose a threat to health. Sometimes, due to various factors, the immune system gets out of order and mistakenly starts attacking the body’s own tissue by perceiving it as a threat, leading to an autoimmune condition. When it starts targeting liver tissue, the organ undergoes severe inflammation and damage, causing autoimmune hepatitis.

Autoimmune hepatitis can occur in anyone, irrespective of the age group. It is more prevalent in women and is often associated with other types of autoimmune conditions.

Common Causes of Autoimmune Hepatitis

Experts are unable to pinpoint the exact causes of autoimmune hepatitis. However, the disease is considered to be due to a mixture of the following causes: 

Environmental triggers 

This includes anything in the external environment, such as a virus, a toxin, or a medication.

Genetic risk

Carrying certain genes often increases the risk of autoimmune diseases, including autoimmune hepatitis.

Autoimmunity

People with other autoimmune diseases, such as Grave’s disease (autoimmunity against the thyroid gland), rheumatoid arthritis (autoimmunity against joint tissue), and psoriasis (autoimmunity against the skin) are more likely to develop autoimmune hepatitis.

Autoimmune Hepatitis Symptoms

The symptoms of autoimmune hepatitis vary from mild to severe. Sometimes, the person is completely asymptomatic, especially in the early stages of the disease. Some people may not develop any symptoms in the beginning and acquire them slowly over time, while others may develop them much more quickly, sometimes in a matter of days. 

Irrespective of the pattern of development, autoimmune hepatitis is usually characterized by:

  • Excessive fatigue
  • A general feeling of being unwell all the time
  • Pain in joints, worse in the morning
  • Nausea
  • Low appetite
  • Excessive itching and skin rash
  • Diarrhea
  • Bloating and abdominal pain
  • Irregular or absent menstrual cycle
  • Excessive hair growth, especially in females
  • Weight loss

In most cases, the symptoms are nonspecific and not enough to form a solid diagnosis. Hence, your doctor may consider ordering a few extra tests before an official diagnosis is given.

As the disease progresses, the following, more severe symptoms may occur:

  • Confusion
  • The build-up of fluid in ankles and feet
  • Extra fluid in the tummy
  • Bruising on the skin
  • Dark urine and pale stools
  • Appearance of abnormal vessels on the skin

Diagnosing Autoimmune Hepatitis

The following tests are commonly suggested to confirm the diagnosis of autoimmune hepatitis and differentiate it from other types of hepatitis:

Blood tests

This includes taking a blood sample from one of your veins and checking for antibodies to distinguish autoimmune hepatitis from other causes of hepatitis.

Liver Biopsy

In cases with high suspicion, a doctor may suggest undergoing a biopsy. This includes inserting a thin needle into your body through a tiny skin incision and withdrawing a small piece of liver tissue. This liver sample is then analyzed under a microscope to confirm the diagnosis and rule out other possibilities. 

Complications of Autoimmune Hepatitis

If timely diagnosis and management are not commenced, autoimmune hepatitis can lead to severe damage, sometimes resulting in cirrhosis. Liver cirrhosis can further complicate the situation and cause the following:

Esophageal varices

Sometimes, autoimmune hepatitis blocks the circulation of blood in the portal vein, the major vein of the liver. This causes blood to pool into other blood vessels of the body, mainly in the esophagus and stomach. These thin-walled vessels eventually burst, causing bleeding. The condition is life-threatening and requires urgent medical attention.

Ascites

Damage to the liver often causes large amounts of fluid to collect in the abdomen, causing ascites. The issue is often uncomfortable and can interfere with the normal pattern of breathing.

Liver Failure

In the long run, autoimmune hepatitis causes extensive damage to the liver, leading to liver failure. At this point, the only reliable treatment is a liver transplant.

Autoimmune Hepatitis Treatment

Treatment for autoimmune hepatitis

Unfortunately, there is no cure for autoimmune hepatitis. The treatment plan focuses on relieving symptoms and improving the quality of life while preventing further liver damage. As per the National Institute for Diabetes and Digestive and Kidney Disease, the treatment for autoimmune hepatitis must be commenced as early as possible to reduce the risk of complications.

The mainstay of treatment is to stop or at least slow down your immune system from attacking the liver. To meet this goal, medication to reduce the immune activity is prescribed. This includes Prednisolone, a steroid, which is usually combined with another medicine called Azathioprine to reduce the side effects of the former.

A liver transplant is considered the last resort and offered when the liver has sustained irreparable damage that cannot be reversed. The process involves a lengthy, complex surgical procedure in which your damaged liver is replaced by a healthier one from a donor who closely matches your blood chemistry.

Are There Any Natural Remedies for Autoimmune Hepatitis?

Unfortunately, there are no magical natural remedies to cure autoimmune hepatitis. It is best to speak with your doctor about supplements and lifestyle changes you can make to best aid your liver during this process. Each person is an individual and a program should be tailored to their individual needs. It is important to make sure no additional harm or stress is not put on the liver. Eating healthily and limiting the consumption of alcohol have also been recommended to maintain good health and reduce weight gain due to steroid treatment.

Eat Healthily

While there aren’t any specific dietary restrictions for autoimmune hepatitis, doctors advise eating a healthy diet to control weight gain and improve overall health. This is because prednisolone, a commonly prescribed drug for autoimmune hepatitis, is linked with weight gain. It is said to slow down the body’s metabolism, increase water retention, and enhance appetite, causing the body to accumulate fat.

The following tips are recommended for people with autoimmune hepatitis to ensure optimal body weight and overall health:

  • Try eating a balanced diet by incorporating foods from all food groups. Eat plenty of fruits, vegetables, beans, meat, oil, and dairy but make sure not to go over the board with any one of them.
  • Consume high-fiber foods to help your liver work optimally. These foods include cereals, rice, whole-grain bread, and fruits and vegetables.
  • Water prevents dehydration while helping your liver work optimally. So make sure to stay hydrated.
  • Stay away from foods high in sugar, salt and fat as much as possible. Cut back on fried food, fast food, and raw or undercooked seafood, especially clams and oysters.

Cut Back on Alcohol & Smoking

While autoimmune hepatitis is not triggered by alcohol, it is important to consider cutting back on your daily alcohol consumption. This is because alcohol consumption has often been related to liver disease and can potentially worsen liver health if taken in large amounts.

A low-to-moderate consumption of alcohol is deemed safe for people with no risk of liver disease. Nevertheless, people with autoimmune hepatitis must still seek expert advice to determine a safe level of alcohol consumption depending on their current health and liver health. Considering the fact that alcohol may interact with a variety of medicines, a doctor is likely to suggest reducing its intake at the very least.

Similarly, smoking is also likely to damage the liver along with other organs of the body. Hence, consider cutting back on your daily number of cigarettes if you have been a chronic smoker.

Help is available to support your journey of getting out of addictions. Talk to your doctor or search for local support groups and clinics that help you medically and emotionally through your journey of quitting alcohol and smoking.

Outlook

Unfortunately, autoimmune hepatitis is incurable. Nevertheless, treatment options are available that may help you enter a state of remission where you no longer have active symptoms. Once you enter remission, a doctor may reduce your medication or stop the treatment.

However, remember that being in remission does not mean that your disease has been cured. There is always a chance of relapse due to which following a healthy life and avoiding alcohol with frequent follow-ups is recommended.

To your health and happiness, Doctor Danielle

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