What Are The Symptoms Of Autoimmune Hepatitis In A Child
Both Type I and Type II autoimmune hepatitis have similar symptoms. Autoimmune hepatitis symptoms can come on suddenly or may develop over time. Some children with autoimmune hepatitis do not show any obvious symptoms such children may only be diagnosed because of abnormal blood test results. When symptoms do appear, they may include:
- Pale or gray stool
- Aches in joints
Hepatitis Cases In Children
The number of cases of hepatitis in children has increased recently. Public health doctors and scientists are looking into what could be causing this.
See a GP if your child has symptoms of hepatitis, including yellowing of the eyes and skin .
Good hygiene, including supervising hand washing in young children, can help to prevent infections that can cause hepatitis.
Treatments For Autoimmune Hepatitis
Treatment works best when AIH is diagnosed early. The goal in treating AIH is to slow or stop the bodys immune system from attacking the liver. The medications used are immunosuppressants, such as prednisone and Imuran® . Physicians usually prescribe a high initial dose of prednisone, and then taper it down progressively as symptoms and liver enzymes improve. Most people will need to take medication for the rest of their lives. Since prednisone can cause a wide range of side effects, Imuran® is often used in conjunction to allow for a lower dose of the prednisone.
Some people may go into remission, during which physicians can effectively discontinue treatment others will relapse after stopping treatment, and will then need to restart the medication and continue on long-term maintenance therapy. A few patients may eventually be tapered off the prednisone completely and stay solely on Imuran®. For those who do not respond to, or relapse from, the combination regimen, then stronger immunosuppressive agents such as mycophenolate mofetil, cyclosporine, or tacrolimus may be considered. When medications do not halt the progress of the disease, or complications from cirrhosis have developed, the remaining option is a liver transplant. Fortunately, the success rate of transplantation in people with AIH is excellent.
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How Is Autoimmune Hepatitis Treated In A Child
Autoimmune hepatitis is a serious, long-lasting disease. Right now, there is no cure for autoimmune hepatitis. Fortunately, most children with autoimmune hepatitis respond well to treatment.
The goal of autoimmune hepatitis treatment is remission. This means symptoms become less severe and liver damage slows or stops. Some children are able to stop taking medicine after two or three years. These children will still need to be watched for a return of autoimmune hepatitis symptoms and other health issues.
Two main types of medicine are used to help control autoimmune hepatitis in children:
- Corticosteroids . Prednisone helps stop the immune system from attacking the liver. It also reduces liver inflammation. Budesonide is another corticosteroid that is sometimes used it has less side effects, but it is mostly given later on when the disease is under control already.
- Immunosuppressants. Azathioprine or mercaptopurine are often added to the treatment they work together with prednisone to get the immune system under control. There are other medications to suppress the immune system that can be used if the standard treatment is not working well.
How We Care For Autoimmune Hepatitis
The Center for Childhood Liver Disease at Boston Childrens Hospital specializes in helping infants, children, adolescents, and young adults with a wide variety of liver disorders. Children with liver disease come to us from all over the world because of our extensive experience, dedication, and commitment to finding solutions.
We offer comprehensive care plans focused on your childs long-term health and wellbeing. Our clinical services include invasive and noninvasive testing and follow up based on your childs needs. When autoimmune hepatitis is part of a broader disorder involving multiple autoimmune diseases, we collaborate with experts in the Rheumatology Program and Immunology Program to develop the best possible care plan for the child. These, and the many other resources we offer, make Boston Childrens a unique and powerful force in fighting autoimmune hepatitis.
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What Are The Symptoms
- In up to 35 percent of cases, autoimmune hepatitis may not present with any symptoms even though signs of liver failure or chronic liver disease are present.
- Generally the presentation includes one or more symptoms that are often nonspecific, such as:
- Upper right abdominal pain
- Absence of menstruation
The Impact Of Immunosuppressant Therapy On Prognosis
Prior to the 1970s, most individuals diagnosed with autoimmune hepatitis died from their disease. Multiple studies in the early 1970s demonstrated the positive impact of corticosteroid therapy on disease outcomes. Sherlock and colleagues looked at the long-term impact of prednisolone therapy on survival and found that 63% of treated patients were alive at 10 years compared with only 27% of untreated patients in the control group . The median survival in the treatment group was 12.2 years versus 3.3 years in the control group.
More recent literature described markedly improved outcomes with immunosuppressive treatment. Czaja and colleagues reported a 90% transplant-free survival at 10 years for patients without cirrhosis at presentation and 89% for patients with cirrhosis at presentation. These survival rates were similar to those of the general population.
Studies utilizing serial liver biopsies have demonstrated how successful immunosuppressive therapy can improve both liver inflammation and fibrosis, potentially preventing the development of cirrhosis.
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Can You Drink Alcohol With Autoimmune Hepatitis
As all alcoholic beverages can cause further harm to your liver, ideally you should avoid drinking. Failing that, you should only drink in very small amounts. Alcohol causes inflammation and can be a sole cause of hepatitis. If your liver is already inflamed, drinking can speed up liver damage that leads to serious illness.
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How Is It Treated
- Factors that influence the treatment approach include the severity of symptoms, liver biopsy findings, antibody and liver enzyme levels, and the ability of the patient to handle treatment side effects.
- In asymptomatic patients with normal biopsy results, liver enzymes, and antibody levels, treatment is not usually recommended as the risk of progression is very low.
- When symptoms are present, immune suppressants such as prednisone are a common choice. This treatment can relieve acute symptoms in up to 80 percent of cases, but most patients will eventually experience relapse. It is sometimes combined with azathioprine in less tolerant patients.
- Budesonide also appears to be effective in inducing relapse, but more evidence is needed.
- Other immune suppressants may be tried if the patient doesnt respond to the above therapies, such as:
What Causes Autoimmune Hepatitis In Children
It is not known exactly why the immune system begins attacking liver cells in children with autoimmune hepatitis.
Experts are looking at a number of possible causes, including:
- Genetics. Physical traits passed down from parents
- Environment. Causes of disease from outside the body, such as toxic substances, certain medicines, or germs
- Problems with the immune system. For example, in patients with autoimmune hepatitis, it seems that some cells that regulate the immune system are fewer or weaker, while other cells that make the immune system attack are more frequent or more active.
Inside the Liver Center: Meet Dr. Weymann
Dr. Weymann leads a team of highly skilled specialists dedicated to caring for children suffering from a wide range of liver diseases. Named to the Best Doctors in America list, Dr. Weymann understands that liver problems can be life-threatening and life-changing. Quick evaluation, correct diagnosis and early treatment can impact long-term health.
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Search For A Clinical Trial
Clinical trials are research studies that test how well new medical approaches work in people. Before an experimental treatment can be tested on human subjects in a clinical trial, it must have shown benefit in laboratory testing or animal research studies. The most promising treatments are then moved into clinical trials, with the goal of identifying new ways to safely and effectively prevent, screen for, diagnose, or treat a disease.
Speak with your doctor about the ongoing progress and results of these trials to get the most up-to-date information on new treatments. Participating in a clinical trial is a great way to contribute to curing, preventing and treating liver disease and its complications.
Start your search here to find clinical trials that need people like you.
What Are The Complications Of Autoimmune Hepatitis In A Child
Autoimmune hepatitis can cause scar tissue to start forming on the damaged liver . This makes it harder for the liver to work properly. Over time, lots of scar tissue can build up in the liver . This can block the blood flowing through the liver and may lead to problems such as bleeding in the esophagus or stomach, or water in the belly . Cirrhosis also can cause the liver to fail signs may be jaundice , bleeding/bruising, or confusion.
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Pearls And Other Issues
Prognosis can vary widely but appears to be most dependent on treatment. Several randomized, controlled trials have shown that untreated autoimmune hepatitis patients have a 5-year and 10-year survival rate of 50% and 10%, respectively. Sixty percent to 80% of patients will enter remission after the proposed duration of treatment. Approximately 50% of these patients will relapse requiring therapy resumption. Some patients require life-long immunosuppression. Treatment failure occurs in 10% of patients that undergo treatment with prednisone. For those who undergo liver transplantation, approximately a third of patients have a recurrence of autoimmune hepatitis.
Enhancing Healthcare Team Outcomes
The diagnosis and management of autoimmune hepatitis are complex and best done by an interprofessional team that includes a gastroenterologist, pharmacist, internist, and hepatologist. Specialized gastrointestinal nurses assist in the care, education of the patient and family, and coordination of the treatment and follow-up. It is now well established that the use of corticosteroids leads to complete remission and in most cases improves mortality. The American Association for the Study of Liver Diseases recommends monotherapy with prednisone or combination therapy with prednisone and azathioprine. The pharmacist should educate the patients on all the potential complications of steroids and when to seek medical help. At the same time, the primary care provider and nurse practitioner should thoroughly examine the patient for worsening of the liver condition.
The prognosis for most patients with autoimmune hepatitis is guarded. While survival has improved over the past 2 decades, it still is low. Relapse of the condition is common and some patients may benefit from a liver transplant.
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Can Stress Cause Autoimmune Hepatitis
The link between stress and autoimmune disease has been implicated in many studies. One study found a significantly higher incidence of autoimmune diseases, such as rheumatoid arthritis and lupus, among those previously diagnosed with stress-related illnesses2.
Another that focused specifically on people living with autoimmune hepatitis found that those who were stressed were more likely to relapse 3.
What’s autoimmune hepatitis and how does it differ from other forms?
Type 2 Autoimmune Hepatitis
Autoantibodies characteristic of type 2 autoimmune hepatitis are the following:
Antibodies to liver-kidney microsome alone or accompanied by antiliver cytosol antibody-1 . Positive titers are defined as > 1:20 for ANA and ASMA, whereas titers of 1:10 may be considered positive for anti-LKM-1. However, some patients have only ALC-1 antibodies. In addition, approximately 10% to 30% of patients with type 2 disease will have anti-SLA/LP antibodies. Antibodies to liver-kidney microsome-3 are rarely seen in type 2 disease and are not useful in clinical practice.
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How Is Autoimmune Hepatitis Diagnosed
The symptoms of autoimmune hepatitis may be mild at first and are similar to the flu, so it may not be diagnosed immediately. The doctor will perform a physical examination of the patient and ask about the family medical history. The doctor may also order certain tests, including:
- A blood test to check for inflammation in the liver, to evaluate the patients liver function, and to check for antibodies associated with autoimmune hepatitis.
- Ultrasound of the liver. Ultrasound is a procedure that transmits high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photographic images of the inside of the body.
- If necessary, the doctor may also order a liver biopsy, the removal of a small piece of tissue from the liver to be analyzed in the lab for disease.
How Rare Is Autoimmune Hepatitis
It is thought that around 10,000 people in the UK are living with autoimmune hepatitis1. This makes up a small percentage of people living with a type of hepatitis – where your liver becomes inflamed risking further liver damage and serious complications.
The type of hepatitis you have is related to what caused this liver inflammation. These are all treated differently, and fall into the following categories:
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Potential Outcomes Of Immunosuppressant Therapy
The goal of treatment is disease remission. In remission, patients experience the improvement of symptoms, the normalization of abnormal liver chemistries and gamma globulin levels, and the reduction or elimination of inflammatory activity on liver biopsy.
Most patients who embark on a course of immunosuppressant therapy respond well initially. More than 90% of adults started on corticosteroid treatment experience improvements in liver chemistries and gamma globulin levels within 2 weeks.
Remission, if it is to be achieved, typically requires 18-24 months of immunosuppressant therapy. Remission can be achieved in about 65% of patients within 18 months and 80% of patients within 3 years. Once a drug-induced remission is achieved, an attempt should be made to withdraw immunosuppression. However, a sustained remission after total drug withdrawal is seen in 13% of patients at 5 years. Patients who relapse need to restart long-term immunosuppressant therapy in an effort to normalize their biochemical abnormalities and to delay the progression of liver disease. Many such patients are maintained on chronic maintenance therapy with azathioprine.
About 13% of patients experience an incomplete response to treatment, without worsening of their condition. Most incomplete responders need long-term immunosuppression in an attempt to stabilize levels of aspartate transaminase and alanine aminotransferase andby extensionprevent disease progression.
Risk Factors Identified For Autoimmune Hepatitis After Liver Transplant
Study by international consortium including UT Southwestern provides insight into rare liver condition
DALLAS May 20, 2022 A multicenter study performed by a large international consortium that includes UT Southwestern has outlined a set of risk factors and outcomes for patients with autoimmune hepatitis that recurs after liver transplantation. The findings, published in the Journal of Hepatology, represent a first step toward better managing and potentially preventing this uncommon condition.
Autoimmune hepatitis is a very rare disorder of the liver, and liver transplant is a rare surgical procedure, with only 9,236 performed in the United States in 2021. Only a small fraction of liver transplants are performed for autoimmune hepatitis, so its difficult to make any observations about risk or outcomes at a single medical center because the number of patients seen there will be so small, said study author , Assistant Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UT Southwestern, who contributed data from UTSW patients to the study with colleague , Professor of Internal Medicine in the Division of Digestive and Liver Diseases. Thats why the International Autoimmune Hepatitis Group exists, to pull together information on large numbers of patients.
About UT Southwestern Medical Center
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How Common Is Autoimmune Hepatitis
Researchers arent sure how common autoimmune hepatitis is in the United States. Studies conducted in northern European countries have found that between 10 and 24 of every 100,000 people in that region have autoimmune hepatitis. Researchers have found that the disease is more common among Alaska Natives, affecting about 43 of every 100,000 people.1
When The Liver Is Under Attack
In people with autoimmune hepatitis, immune cells inappropriately mistake the liver’s normal cells as abnormal and attack them. Over time, this can lead to inflammation, scarring , impaired liver function, and even cirrhosis , which can result in liver failure, and death if not treated. Some people may eventually need a liver transplant. The liver disease specialists at NewYork-Presbyterians Center for Liver Disease and Transplantation are experienced in diagnosing and treating autoimmune hepatitis.
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What Is Autoimmune Hepatitis
Autoimmune hepatitis is a rare but serious disease of the liver. Autoimmune means that the body attacks itself in this case, it mistakes healthy tissue and cells for infected tissue and cells and sends out antibodies to attack the healthy liver cells.
Hepatitis occurs when the healthy tissue of the liver become inflamed. If not treated, the problem may advance to cirrhosis of the liver, and ultimately to liver failure. If the liver becomes severely damaged, a liver transplant may be necessary.
Autoimmune hepatitis is categorized as Type 1 or Type 2:
- Type 1 is diagnosed in adolescents or adults. This type is more common and is usually found in North America.
- Type 2 is diagnosed mostly in children and can be more difficult to treat.