Autoimmune Hepatitis Q&A with Karin Cesario, MD

What is autoimmune hepatitis?

“Hepatitis” is a general term meaning “inflammation of the liver.”  Many things can cause hepatitis including medications, viruses and alcohol.  In autoimmune hepatitis, the body’s immune system attacks liver cells leading to liver inflammation.

What causes autoimmune hepatitis?

It is not yet clear what causes autoimmune hepatitis.  Scientists believe that some people have a genetic predisposition to autoimmune hepatitis (along with other autoimmune diseases).  Some environmental exposure, such as medications or infection, may trigger development of the disease. Most cases of autoimmune hepatitis occur in middle-aged or older women.

What are the symptoms of autoimmune hepatitis?

Many patients with autoimmune hepatitis have no symptoms and are diagnosed after an evaluation of persistently abnormal blood tests.   When chronic symptoms are present, people may experience fatigue, joint pains or itching. With a severe bout of autoimmune hepatitis, people may experience nausea, vomiting, abdominal pain, jaundice (yellowing of the skin or eyes), dark urine or pale stools.  

How is someone diagnosed with autoimmune hepatitis?

Autoimmune hepatitis is often suspected based on blood work.  A liver biopsy may be ordered to confirm the diagnosis, determine the severity and/or rule out other causes of liver disease.

What is the treatment of autoimmune hepatitis?

Not everyone with autoimmune hepatitis needs treatment.   The decision to start therapy is based on the severity of the disease and if symptoms are present.    When medical therapy is pursued, autoimmune hepatitis is usually treated first with a glucocorticoid such as prednisone or budesonide.   Over time, a person with autoimmune hepatitis will often be transitioned from a glucocorticoid to a second medication such as azathioprine or 6- mercaptopurine.   Rarely, methotrexate or mycophenolate mofetil may be used. All autoimmune hepatitis medications need to be supervised closely by a physician due to potential side effects.  Regular clinic check-ups with blood work are required.

If started on medication for autoimmune hepatitis, will I ever get off?

Autoimmune hepatitis medications are usually continued until the disease is in remission, the treatment fails or the person develops severe side effects.   Remission is defined as a lack of symptoms, normal liver tests and near normal liver biopsy. Ten to forty percent of people with autoimmune hepatitis can minimize or discontinue their medications.  Unfortunately, most people with autoimmune hepatitis must eventually start treatment again due to relapse.

Other than medications for autoimmune hepatitis, what else can I do to keep my liver healthy?

No specific diet has been shown superior for controlling autoimmune hepatitis.  Therefore, eating a balanced diet and avoiding alcohol is recommended. No herbal medications have been proven to improve outcomes in autoimmune hepatitis either.   Some herbal medications can actually cause serious liver damage. Particularly if cirrhosis is present, all supplements and new prescription medications should be checked by a liver specialist.

What is the long-term prognosis for autoimmune hepatitis?

Early identification and appropriate treatment of autoimmune hepatitis can prevent liver scarring.   Untreated autoimmune hepatitis may lead to severe scarring of the liver (cirrhosis), liver failure or liver cancer.   Some patients with severe cases of autoimmune hepatitis may require a liver transplant.