Autoimmune hepatitis is defined as a disease with un-resolving peri-portal hepatitis usually with hyper-gamma-globulinaemia and tissue auto-antibodies, which is responsive to immunosuppressive therapy.
Etiology/Cause is unknown.
Autoimmune hepatitis is a disease or deranged immunoregulation, marked by defect in suppressor regulatory T cells.
This leads to auto-antibodies against hepatocyte surface antigens.
Antinuclear antibodies (ANA) are present in 80% of patients.
Double stranded DNA is increased in all types of chronic hepatitis with highest titers in autoimmune hepatitis, where it disappears with steroid therapy.
Anti smooth muscle antibody (ASMA) is present in 70% of patients with autoimmune hepatitis.
This antibody is regarded as a result of liver cell injury.
Anti-liver kidney microsomal Type I antibody (LKM) is associated with severe autoimmune hepatitis.
Autoimmune hepatitis mostly affects females and is usually associated with other autoimmune disorders.
It also could be hereditary.
Types Of Autoimmune Hepatitis
Based on the presence of various antibodies autoimmune hepatitis has been classified into 3 types.
Type I Autoimmune Hepatitis – seen in elderly women. The disease has a slow course and is recognized by positive test for ANA or ASMA.
Type II Autoimmune Hepatitis - usually seen in young females; especially children.
Type III Autoimmune Hepatitis – is rarely seen in pediatric age group. In these patients ANA, ASMA and LKM are absent. They are recognized by positive, anti-SLA antibodies (soluble live antigen).
Clinical Features Of Autoimmune Hepatitis
Onset is gradual. About 25% of cases present as acute viral hepatitis. It is been suggested that hepatitis C virus infection can induce autoimmune hepatitis.
Frank jaundice is often episodic and deep cholestatic jaundice is rare.
Amenorrhea is seen in females.
Epistaxis, bleeding gums and easy bruising with minimal trauma are other complaints.
Face may be rounded even before steroid therapy and acne with or without hirsute.
Livid cutaneous striae may be found on thigh, abdomen and upper arms.
In early stages, liver is firm with splenomegaly. Ascites, edema are late features.
Other autoimmune diseases like Hashimoto’s thyroiditis, arthralgia, renal tubular defects, lupus kidney may be associated.
Criteria followed for Autoimmune Hepatitis diagnosis
1. Evidence of chronic liver disease.
2. Presence of antibodies (ASA, ASMA, LKM or SLA).
3. Hyper-gamma-globulinaemia.
4. Suggestive histology.
Treatment Of Autoimmune Hepatitis
Corticosteroid and azathioprine are effective in controlling clinical condition and prolonging life.
With adequate treatment, the response is so dramatic as to be almost diagnostic.
Cydosporine is used in patients resistant to steroid therapy.
Some alternative therapies that can help autoimmune hepatitis include:
- Detoxification of blood is essential. Use herbs like yarrow and sarsaparilla. They will help in reducing inflammation in liver.
- Milk Thistle extract is known to benefit in liver disorders.
- Deep breathing exercises will help enhance your concentration levels and improve your immune system.
Never try to use alternative medicines as a substitute to qualified medical care. Autoimmune disease will subsequently result in degeneration of the liver and hence appropriate medical advice should be sought from time to time.
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