What Are The Symptoms And Complications Of Autoimmune Hepatitis
Often, the symptoms of autoimmune hepatitis are minor. When symptoms do occur, the most common are fatigue, abdominal discomfort, aching joints, itching, jaundice , enlarged liver, nausea and spider angiomas on the skin. Other symptoms may include dark urine, loss of appetite, pale stools and absence of menstruation. More severe complications can include ascites and mental confusion. In 10%-20% of cases, autoimmune hepatitis may present with symptoms like an acute hepatitis.
When To Start Treatment
Treatment should be started in patients with significant disease, characterized by at least one of the following: AST or ALT > 10 times the upper limit of normal AST or ALT > 5 times the upper limit of normal and IgG > 2 times the upper limit of normal bridging necrosis or multiacinar necrosis on histology. Although uncommon, the presence of incapacitating symptoms has also been proposed as an indication of treatment regardless of laboratory values.
In asymptomatic patients with AST, ALT, and gamma globulins/IgG elevations that do not meet the criteria above, the benefit of treatment is less clear. The course of the disease in such patients has not been well established and there is little data to support treatment. Thus in asymptomatic patients with only mild laboratory and histological changes, the decision to start treatment should be individualized and the risks of therapy taken into account. Often treatment in this situation can be postponed and liver tests followed closely. Such patients should always be referred to a hepatologist or gastroenterologist for decision regarding therapy.
Asymptomatic patients with inactive disease on liver biopsy or burned out cirrhosis do not benefit from treatment.
How Is Autoimmune Hepatitis In Children Diagnosed
Your childs health care provider will do several tests to look for autoimmune hepatitis and other related diseases. These tests may include:
- Blood tests
- Liver biopsy
- Special scans of the liver, such as ultrasound and magnetic resonance cholangiopancreatography
- Exam of the inside of the intestines , under anesthesia
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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.
What Is The Treatment For Autoimmune Hepatitis
Treatment is almost always needed. Early treatment can improve symptoms, reduce the risk of complications, and also greatly improve your outlook . Treatment aims to reduce inflammation and suppress the immune system with immunosuppressant medicines:
- Steroid medication is the usual first treatment. Steroids are good at reducing inflammation. A high dose is usually needed at first. The dose is then gradually reduced over a few weeks. The aim is to find the lowest dose needed to control the inflammation. The dose needed varies from person to person. See the separate leaflet called Oral Steroids for more detail.
- Azathioprine is an immunosuppressant medicine that works in a different way to steroids. It is usually used in addition to the steroid. A steroid plus azathioprine tends to work better than either alone. Also, the dose of steroid needed is usually less if you also take azathioprine. This means that any side-effects from steroids may be less severe.
Treatment works well in most cases. Usually, the inflammation settles and symptoms improve within a few months of starting treatment. However, it may take a year or more to get the disease totally under control. Azathioprine is usually taken for at least two years.
For some people a liver transplant may be an option – for example:
- In the few people who do not respond to treatment with the medicines mentioned above or
- In people diagnosed in the late stage of the disease with severe ‘scarring’ of the liver or liver failure.
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Chronic Inflammation Vs Autoimmunity
Chronic inflammatory processes and autoimmunity have a lot of similarity but also some differences. Autoimmunity is usually associated with an overall chronic inflammatory process. However, one could have a chronic inflammatory condition without having autoimmunity.
A chronic inflammatory process is when some sort of trigger initiates a strong inflammatory process that causes collateral damage to other tissues of the body such as the gut lining, blood vessels, the sinuses, the lungs, the joints, etc. This would create conditions such as inflammatory bowel disease, heart disease, allergies, asthma, osteoarthritis, etc.
An autoimmune condition is when the bodies white blood cells produce a specific antibody to target a particular tissue or enzyme within a tissue of the body. For example, in Hashimotos thyroiditis, the body will produce an anti-body to attach certain enzymes such as thyroid peroxidase or thyroglobulin that work to produce thyroid hormone.
So the big difference between chronic inflammatory conditions and autoimmunity is that in CICs we have tissue damage resulting as an indirect effect of the inflammatory process. While in autoimmunity we see tissue damage as a direct effect of the inflammatory process.
Boost Up Your Glutathione
Glutathione is considered the master anti-oxidant within the body and is produced by every cell in the body where it functions to protect our DNA. Glutathione is our cells security guard that protects the cellular components from outside free radical attack. Longevity scientists now believe that the level of glutathione in our cells has a direct relationship with how long we will live .
Glutathione plays a very important role in establishing immune tolerance . Studies have demonstrated that glutathione enhances the function of T cells and modulates immune activity . In this way, optimizing glutathione levels are extremely important for reducing collateral damage associated with inflammation and autoimmune reactions .
This article goes into more detail on glutathione and its role in reducing inflammation. Hopefully, this article has given you hope and several major action steps to reduce inflammation and heal autoimmune disease.
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What Are The Causes Of Autoimmune Hepatitis
Autoimmune hepatitis occurs when the white blood cells of the body produce an inappropriate immune response against the liver cells, thereby causing inflammation and damage. The exact cause of autoimmune hepatitis is not known. Affected people may have a genetic predisposition for the condition, which may be triggered by an environmental factor. Around 20% patients suffering from a genetic condition called autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome suffer from autoimmune hepatitis.
The environmental trigger could be:
- Drugs like infliximab, minocycline, atorvastatin, diclofenac, isoniazid, methyldopa, nitrofurantoin, and propylthiouracil, the hepatitis A vaccine, and herbal agents like black cohosh and dai-saiko-to. The autoimmune hepatitis may improve after stopping the medication
- Viruses such as hepatitis A, B, or C, or measles virus
Autoimmune hepatitis is of two main types, type 1 and type 2
- Type 1 autoimmune hepatitis usually first manifests in adolescence or young adults. Females are most commonly affected.
- Type 2 autoimmune hepatitis is less common than type 1 and usually first manifests in children. Its prognosis or outcome is often worse than type 1 disease.
What Are The Types Of Autoimmune Hepatitis
Autoimmune hepatitis is classified into several types. Type 1 autoimmune hepatitis is the most common form in North America. Type 1 can occur at any age however, it most often starts in adolescence or young adulthood. About 70 percent of people with type 1 autoimmune hepatitis are female.1
People with type 1 autoimmune hepatitis commonly have other autoimmune disorders, such as
Type 2 autoimmune hepatitis is less common and occurs more often in children than adults.1 People with type 2 can also have any of the above autoimmune disorders.
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What Are The Symptoms Of Autoimmune Hepatitis
The most common symptoms of autoimmune hepatitis are
- light-colored stools
- jaundice, or yellowing of the skin and whites of the eyes
Symptoms of autoimmune hepatitis range from mild to severe. Some people may feel as if they have a mild case of the flu. Others may have no symptoms when a health care provider diagnoses the disease however, they can develop symptoms later.
Liver Transplantation For Autoimmune Hepatitis
In some people, the inflammation and liver damage of autoimmune hepatitis cannot be well controlled with medication alone. In these cases, our doctors may suggest a liver transplant. At NewYork-Presbyterian, you are ten times more likely to receive a liver transplant than at other hospitals in the region, with an average wait time of just nine months. Our surgeons have performed more than 2,000 liver transplants, with outcomes that meet or surpass national averages. They use a variety of liver transplant approaches, including living donor liver transplantation, to extend the limits of organ transplantation and provide the greatest number of transplants possible.
How Is Autoimmune Hepatitis Treated
The goal of treatment is to stop the bodys attack on itself by suppressing the immune system. This is accomplished with a medicine called prednisone, a type of steroid. Often times, a second drug, azathioprine is also used. Treatment starts with a high dose of prednisone. When symptoms improve, the dosage is lowered and azathioprine may be added. In most cases, autoimmune hepatitis can be controlled but not cured. That is why most patients will need to stay on the medicine for years, and sometimes for life. Unfortunately, long-term use of steroid can cause serious side effects including diabetes, osteoporosis, high blood pressure, glaucoma, weight gain and decreased resistance to infection. Other medications may be needed to control these side effects.
Optimize Your Vitamin D Levels
Vitamin D is considered to be more of a hormone than a vitamin based around its role in the body. Hormones are chemical messengers that communicate with cell receptors to produce specific biological responses in the body. In this way, calcitriol, which is the active form of vitamin D, has the ability to activate over 1,000 genes in the body .
All the major immune cells have vitamin D receptors and these immune cells are all capable of synthesizing the active vitamin D metabolite. Vitamin D modulates the balance between the innate and adaptive immune responses. Studies have shown that vitamin D deficiencies are associated with increased autoimmune development and increased susceptibility to infection .
This article goes into more of the benefits of vitamin D and the best strategies to optimize your levels. You must optimize vitamin D levels to heal autoimmune disease!
If testing reveals they are highly deficient, we will do higher dosages. I also encourage all of my clients to get out in the sun everyday for at least 15 minutes. I rarely see vitamin D levels too high, but on occasion with someone who has been doing high dosage supplementation for an extended time it will happen. This is why you should stay around 5-10,000 IU in supplemental form unless given specific instructions from your health care practitioner.
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S To Reduce Inflammation
Here are the best action steps to get started with on your journey to prevent and/or heal chronic inflammation and autoimmune disease. You should always consult with your physician before stopping or changing medications or taking on new health strategies.
Additionally, you should be working with a functional health practitioner to help guide you through these strategies. This is not an exhaustive list and there are other natural therapeutic strategies that I and functional health practitioners will utilize to help individuals with chronic inflammation and autoimmune disorders.
Genetics And Predisposing Factors
Autoimmune hepatitis is thought to result from an environmental trigger in a genetically predisposed individual, leading to loss of tolerance of T lymphocytes with subsequent hepatocyte attack.
It is a polygenic disease and does not follow a Mendelian distribution. Therefore there is no need to screen family members of patients with AIH. There is a strong genetic association with the alleles of the major histocompatibility complex class II. The presence of human leukocyte antigen genes HLA DRB1*03 and HLA DRB1*04 predisposes to AIH type 1 and affect the disease course and response to treatment. Individuals who are positive for HLA DRB1*03 are younger, respond less favorably to corticosteroid therapy, and progress more often to liver failure. On the other hand, the presence of HLA DRB1*04 is associated with higher rates of concomitant autoimmune disorders.
Autoimmune hepatitis can also be associated with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome, an autosomal recessive disease characterized by hypoparathyroidism, adrenal insufficiency, and chronic mucocutaneous candidiasis. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is the only AIH-associated disease that follows a Mendelian pattern of inheritance and genetic counseling should be offered for patients and family members.
Table 1: Drugs Associated With Drug-Induced Autoimmune-Like Hepatitis
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Common Symptoms Of Hepatitis
If you are living with a chronic form of hepatitis, like hepatitis B and C, you may not show symptoms until the damage affects liver function. By contrast, people with acute hepatitis may present with symptoms shortly after contracting a hepatitis virus.
Common symptoms of infectious hepatitis include:
It is crucial to understand what is causing hepatitis in order to treat it correctly. Doctors will progress through a series of tests to accurately diagnose your condition.
Balance Your Blood Sugar
Blood sugar stability plays a huge role in the inflammatory process. One of the most powerful anti-inflammatory compounds within the body is the stress hormone cortisol. Cortisol is called a glucocorticoid because its primary role is to mobilize glucose.
The antagonist to cortisol is insulin, which takes glucose and puts it into cells. Insulin also has a pro-inflammatory nature, so that the higher the blood glucose, the increased need for insulin and the more inflammatory activity will be produced .
Elevated blood sugar also reduces the strength and tone of the immune system. When the immune system loses its tone, it favors chronic inflammation as a way of prioritizing survival.
When we have blood sugar imbalances, we cycle through periods of both high and low blood sugar. Low blood sugar, signals cortisol levels. Overtime the body becomes resistant to both insulin and cortisol and we end up with increased inflammatory activity . It is critical to get your blood sugar and insulin levels under control in order to reduce inflammation and heal.
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Autoimmune Hepatitis Causes And Risk Factors
Doctors aren’t sure exactly what causes your immune system to turn against your liver. Your genes may have something to do with it, since AIH can run in families.
But genes aren’t the whole story. Something you come into contact with may trigger your genes to set autoimmune hepatitis in motion. This could include:
- Medicines such as statins and hydralazine or antibiotics like nitrofurantoin and minocycline
- Infections such as viral hepatitis, herpes, Epstein-Barr, and measles
What Is It Like To Live With Autoimmune Hepatitis
Autoimmune hepatitis is a chronic condition that may require treatment for the rest of your life. Once your liver function blood tests have returned to a healthy range, your medical team may be able to reduce your steroid use. Most individuals who are treated for autoimmune hepatitis have a good prognosis and do not experience additional complications. While you may need to take a medication every day, you can still go on to live a full, healthy life.
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Identifying Endpoints Of Therapy
Adverse endpoints like malignancy, death or transplantation are impractical for evaluating new therapies in PSC given the long duration of disease. Moreover, the heterogeneity of PSC makes accurate patient selection and stratification for clinical trials difficult, particularly with regard to cholangiographic pattern of disease, the presence and influence of coexisting IBD, and in those having overlapping features with AIH/IgG4-associated cholangitis.
Do Medicines Used To Treat Autoimmune Hepatitis Have Side Effects
Medicines for autoimmune hepatitis can cause side effects. Your doctor will monitor any side effects and help you manage them while you take these medicines. Your doctor also may adjust the doses or change the medicines you take. You may need to stop taking corticosteroids or azathioprine if you have severe side effects.
Side effects of corticosteroids may include
- changes in how you look, which may include weight gain, a fuller face, acne, or more facial hair
- liver damage
Corticosteroids and azathioprine suppress, or decrease the activity of, your immune system, which increases your risk for infections. These medicines can also increase your risk of developing cancers, especially skin cancers.
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Side Effects Of Steroids And Azathioprine
Steroid side effects are dose and time dependent, and arise if a dose exceeding 7.5-10 mg/d is administered over several months. The most common side effect is the development of cushingoid features. In a retrospective monocentric study of 103 adult AIH patients, mostly treated according to a standard protocol with a steroid starting dose of 1 mg/kg per day and a mean follow-up period of 95 mo, 15.5% developed cushingoid features. Although not severe, these changes are often a great concern for the patients, and may lead to non-adherence, with the dangerous consequence of poor disease control. Almost half of AIH patients discontinue steroids because of cosmetic changes or obesity. Severe, but less frequent steroid side effects include osteoporosis, brittle diabetes, cataract, psychosis and hypertension. They are mainly related to the initial high dose, and are reversible. Monitoring of these complications is advisable, including ophthalmologic controls and bone density scans on a regular basis.
Measurement of the azathioprine metabolites 6-TGN and 6-methylmercaptopurine can be helpful in identifying drug toxicity and non-adherence, and in distinguishing azathioprine hepatotoxicity from disease non-response, as shown by a retrospective study in adults, and a small prospective study in children, but an ideal therapeutic level of the 6-thioguanine metabolites has not been established for AIH, unlike for inflammatory bowel diseases .