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Autoimmune hepatitis. Frequently Asked Questions

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In autoimmune hepatitis (AIH), the body's immune system attacks liver cells, which causes it to become inflamed.

  • The disease can manifest itself at any age and in people of any race or gender, although it occurs 4 times more often in women than in men.

Causes of autoimmune hepatitis.

Experts have not established why autoimmune hepatitis develops. It is assumed that some people inherit a genetic predisposition, which increases the likelihood of its development under the influence of various environmental factors.

  • These can be viruses, sometimes dietary supplements, as well as some medications that provoke the development of the disease.

There are two main forms of autoimmune hepatitis:

  • Type 1 AIG can affect people of any age and gender.
  • AIH type 2 mainly affects girls and young women and is less common.

There are also rare forms of autoimmune hepatitis (the so-called variant forms or autoimmune cross syndrome) that have features of both AH and other autoimmune liver diseases (primary sclerosing cholangitis or primary biliary cholangitis). 

  • They occur in about 15% of patients. These variant syndromes may manifest together with AIH at the time of diagnosis or later.

Symptoms of autoimmune hepatitis.

Many people with autoimmune hepatitis have no symptoms.

  • The disorder is often first detected when laboratory tests conducted for an unrelated reason deviate from the norm (for example, during a dispensary examination).

When symptoms are present, the most common is fatigue. Some patients also have:

  • Jaundice (yellowing of the skin or eyes)
  • itching, skin rash
  • joint pain
  • abdominal discomfort
  • nausea, vomiting
  • loss of appetite
  • dark urine and/or lightened stools

With the most advanced form of AIG, it can progress to cirrhosis of the liver.

Diagnosis of autoimmune hepatitis.

AIG is diagnosed using a combination of blood tests and liver biopsy.

  • During the biopsy, a small sample of liver tissue is taken for examination under a microscope. 
  • This will confirm the diagnosis and determine its severity, excluding other causes of liver disease. 

Why should autoimmune hepatitis be treated?

Untreated autoimmune hepatitis can cause the development of liver fibrosis (scar tissue formation) and eventually lead to cirrhosis and liver failure.

  • And properly selected therapy not only improves all symptoms, liver function indicators, but can also prevent fibrosis and cirrhosis of the liver in most patients and leads to regression of severe liver fibrosis even at the stage of cirrhosis.

How is autoimmune hepatitis treated?

Practically all patients should receive special therapy.

  • The decision to prescribe drugs is based on the severity of the symptoms, the severity of the disease and the possible side effects of treatment. 

In some cases, patients with mild autoimmune hepatitis do not require immediate treatment. 

Usually, therapy begins with glucocorticosteroids, and then azathioprine is added.

  • Such treatment is called standard immunosuppressive therapy, because these drugs suppress the wrong response of the immune system, which occurs in autoimmune hepatitis. 
  • Thus, it allows to reduce and stop inflammation in the liver tissue and prevents further formation of fibrosis (formation of connective tissue in the liver or its scarring"). 

It should be noted that this therapy can cause side effects.

  • It is very important to follow all the recommendations of a specialist, regularly undergo dynamic monitoring and tell the doctor about your condition, monitor blood counts.  

Patients who do not respond to standard therapy may be prescribed other medications. 

  • Liver transplantation may be required in rare cases with a very severe course of autoimmune hepatitis or in the presence of liver cirrhosis with complications.
  • In extremely rare cases, immunosuppressive therapy may not be prescribed immediately. In this case, careful dynamic monitoring is recommended, which includes a medical examination and blood tests every few months.

Is the treatment of autoimmune hepatitis lifelong?

As a rule, treatment is continued until the disease reaches remission.

  • It is defined as the absence of symptoms, a normal or close to normal level of liver biochemical parameters, as well as an improvement in the structure of liver tissue (according to biopsy data).
  • The initial period of remission usually occurs 12 months or more after the start of treatment.

Approximately about 50% of patients achieve remission and no longer need therapy.

  • However, only about 20-30% of these patients always remain in remission. 
  • Most require either continuous special therapy with small maintenance doses, or eventually have to resume treatment as the disease becomes active again (relapse).  

Pregnancy and autoimmune hepatitis.

Pregnancy is not contraindicated in patients receiving standard maintenance therapy for autoimmune hepatitis.

  • The main drugs (glucocorticosteroids and azathioprine) are not contraindicated during pregnancy. 

It is recommended to discuss pregnancy planning with a specialist, it is better to plan it when the disease is in remission for at least 12 months.

  • Discontinuation of treatment during pregnancy can lead to a relapse of the disease and is usually not recommended. 
  • Patients need careful monitoring during pregnancy and for several months after delivery due to the risk of increased disease activity.

Recommendations for patients.

Diet. 
No specific diet has been proven to improve outcome in patients with autoimmune hepatitis.

  • A normal, healthy and balanced diet should be followed.
  • It is recommended to avoid foods with excessive amounts of animal fats, refined carbohydrates, which can contribute to obesity (steatosis) of the liver, increase the risk of fatty liver disease and complicate the course of autoimmune hepatitis.

Alcohol.
It should be excluded, as it can lead to additional liver damage. All types of alcoholic beverages are harmful to the liver.

  • The condition of patients who already have liver disease may worsen even with the use of a minimum amount of alcohol.

Regular physical activity.
It is beneficial for general health, but has no particular benefit for patients with autoimmune hepatitis. It is better to consult with your doctor about possible physical exertion.

Taking prescription and over-the-counter medications.
The vast majority of drugs carry out their metabolism through the liver. 

  • Therefore, it is always necessary to consult a doctor and inform him about your illness. If the liver is intact, most medications are safe.
  • Some (with an active disease) will be advised to take a smaller dose of medication.

You should pay attention to such a commonly used over-the-counter drug as paracetamol, which is often used for headaches or when body temperature rises in acute respiratory infections. 

  • In patients with any type of liver disease, the maximum recommended dose is no more than 2000 mg (in several doses) per day. 
  • It is reasonable for patients with chronic liver disease not to take this drug on their own.

Dietary supplements, herbal preparations.
There are a number of claims, especially on the internet, that medicinal plants can improve liver health.

  • However, none of the herbs or their combination improves the results of treatment of patients with autoimmune hepatitis and other chronic liver diseases.
  • Moreover, they can cause serious liver damage, and some - the development of autoimmune hepatitis.
  • For this reason, herbal treatment for liver diseases is not indicated.

Regular visits to a specialist, a hepatologist can help keep the liver as healthy as possible.

Every year, more than 150 patients with autoimmune hepatitis are observed at the Center for Diagnosis and treatment of liver diseases MCSC named after A.S. Loginov. Our hepatologists have accumulated extensive experience in the treatment of this disease.

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GBUZ Moscow Clinical Scientific Center named after Loginov MHD