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Home : Digestive Diseases A-Z List of Topics and Titles : Autoimmune

Hepatitis

Autoimmune Hepatitis

Autoimmune hepatitis affects

the liver.

Autoimmune hepatitis is a disease in which the body's immune system

attacks liver cells. This causes the liver to become inflamed (hepatitis).

Researchers think a genetic factor may predispose some people to

autoimmune diseases. About 70 percent of those with autoimmune hepatitis

are women, most between the ages of 15 and 40.

The disease is usually quite serious and, if not treated, gets worse over

time. It's usually chronic, meaning it can last for years, and can lead to

cirrhosis (scarring and hardening) of the liver and eventually liver

failure.

Autoimmune hepatitis is classified as either type I or II. Type I is the

most common form in North America. It occurs at any age and is more common

among women than men. About half of those with type I have other

autoimmune disorders, such as type 1 diabetes, proliferative

glomerulonephritis, thyroiditis, Graves' disease, Sjögren's syndrome,

autoimmune anemia, and ulcerative colitis. Type II autoimmune hepatitis is

less common, typically affecting girls ages 2 to 14, although adults can

have it too.

[Top]

Autoimmune Disease

One job of the immune system is to protect the body from viruses,

bacteria, and other living organisms. Usually, the immune system does not

react against the body's own cells. However, sometimes it mistakenly

attacks the cells it is supposed to protect. This response is called

autoimmunity. Researchers speculate that certain bacteria, viruses,

toxins, and drugs trigger an autoimmune response in people who are

genetically susceptible to developing an autoimmune disorder.

[Top]

Symptoms

Fatigue is probably the most common symptom of autoimmune hepatitis. Other

symptoms include

enlarged liver

jaundice

itching

skin rashes

joint pain

abdominal discomfort

fatigue

spider angiomas (abnormal blood vessels) on the skin

nausea

vomiting

loss of appetite

dark urine

pale or gray colored stools

People in advanced stages of the disease are more likely to have symptoms

such as fluid in the abdomen (ascites) or mental confusion. Women may stop

having menstrual periods.

Symptoms of autoimmune hepatitis range from mild to severe. Because severe

viral hepatitis or hepatitis caused by a drug—for example, certain

antibiotics—has the same symptoms, tests may be needed for an exact

diagnosis. Your doctor should also review and rule out all your medicines

before diagnosing autoimmune hepatitis.

[Top]

Diagnosis

Your doctor will make a diagnosis based on your symptoms, blood tests, and

liver biopsy.

Blood tests. A routine blood test for liver enzymes can help reveal a

pattern typical of hepatitis, but further tests, especially for

autoantibodies, are needed to diagnose autoimmune hepatitis. Antibodies

are proteins made by the immune system to fight off bacteria and viruses.

In autoimmune hepatitis, the immune system makes antinuclear antibodies

(ANA), antibodies against smooth muscle cells (SMA), or liver and kidney

microsomes (anti-LKM). The pattern and level of these antibodies help

define the type of autoimmune hepatitis (type I or type II).

Blood tests also help distinguish autoimmune hepatitis from viral

hepatitis (such as hepatitis B or C) or a metabolic disease (such as

's disease).

Liver biopsy. A tiny sample of your liver tissue, examined under a

microscope, can help your doctor accurately diagnose autoimmune hepatitis

and tell how serious it is. You will go to a hospital or outpatient

surgical facility for this procedure.

[Top]

Treatment

Treatment works best when autoimmune hepatitis is diagnosed early. With

proper treatment, autoimmune hepatitis can usually be controlled. In fact,

recent studies show that sustained response to treatment not only stops

the disease from getting worse, but also may actually reverse some of the

damage.

The primary treatment is medicine to suppress (slow down) an overactive

immune system.

Both types of autoimmune hepatitis are treated with daily doses of a

corticosteroid called prednisone. Your doctor may start you on a high dose

(20 to 60 mg per day) and lower the dose to 5 to 15 mg/day as the disease

is controlled. The goal is to find the lowest possible dose that will

control your disease.

Another medicine, azathioprine (Imuran) is also used to treat autoimmune

hepatitis. Like prednisone, azathioprine suppresses the immune system, but

in a different way. It helps lower the dose of prednisone needed, thereby

reducing its side effects. Your doctor may prescribe azathioprine, in

addition to prednisone, once your disease is under control.

Most people will need to take prednisone, with or without azathioprine,

for years. Some people take it for life. Corticosteroids may slow down the

disease, but everyone is different. In about one out of every three

people, treatment can eventually be stopped. After stopping, it is

important to carefully monitor your condition and promptly report any new

symptoms to your doctor because the disease may return and be even more

severe, especially during the first few months after stopping treatment.

In about 7 out of 10 people, the disease goes into remission, with a

lessening of severity of symptoms, within 2 years of starting treatment. A

portion of persons with a remission will see the disease return within 3

years, so treatment may be necessary on and off for years, if not for

life.

[Top]

Side Effects

Both prednisone and azathioprine have side effects. Because high doses of

prednisone are needed to control autoimmune hepatitis, managing side

effects is very important. However, most side effects appear only after a

long period of time.

Some possible side effects of prednisone are

weight gain

anxiety and confusion

thinning of the bones (osteoporosis)

thinning of the hair and skin

diabetes

high blood pressure

cataracts

glaucoma

Azathioprine can lower your white blood cell count and sometimes causes

nausea and poor appetite. Rare side effects are allergic reaction, liver

damage, and pancreatitis (inflammation of the pancreas gland with severe

stomach pain).

[Top]

Other Treatments

People who do not respond to standard immune therapy or who have severe

side effects may benefit from other immunosuppressive agents like

mycophenylate mofetil, cyclosporine or tacrolimus. People who progress to

end stage liver disease (liver failure) and/or cirrhosis may need a liver

transplant. Transplantation has a 1-year survival rate of 90 percent and a

5-year survival rate of 70 to 80 percent.

[Top]

Hope Through Research

Scientists are studying various aspects of autoimmune hepatitis to find

out who gets it and why and to discover better ways to treat it. Basic

research on the immune system will expand knowledge of autoimmune diseases

in general. Epidemiologic research will help doctors understand what

triggers autoimmune hepatitis in some people. Research on different

steroids, alternatives to steroids, and other immunosuppressants will

eventually lead to more effective treatments.

[Top]

Points to Remember

Autoimmune hepatitis is a long-term disease in which your body's immune

system attacks liver cells.

The disease is diagnosed using various blood tests and a liver biopsy.

With proper treatment, autoimmune hepatitis can usually be controlled. The

main treatment is medicine that suppresses the body's overactive immune

system.

[Top]

For More Information

American Liver Foundation (ALF)

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837),

1–888–4HEP–USA (443–7872),

or 212–668–1000

Fax: 212–483–8179

Email: info@...

Internet: www.liverfoundation.org

[Top]

The U.S. Government does not endorse or favor any specific commercial

product or company. Trade, proprietary, or company names appearing in this

document are used only because they are considered necessary in the

context of the information provided. If a product is not mentioned, this

does not mean or imply that the product is unsatisfactory.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Email: nddic@...

The National Digestive Diseases Information Clearinghouse (NDDIC) is a

service of the National Institute of Diabetes and Digestive and Kidney

Diseases (NIDDK). The NIDDK is part of the National Institutes of Health

of the U.S. Department of Health and Human Services. Established in 1980,

the Clearinghouse provides information about digestive diseases to people

with digestive disorders and to their families, health care professionals,

and the public. The NDDIC answers inquiries, develops and distributes

publications, and works closely with professional and patient

organizations and Government agencies to coordinate resources about

digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both

NIDDK scientists and outside experts. This publication was reviewed by

Willis Maddrey, M.D., University of Texas Southwestern Medical Center at

Dallas; and Krawitt, M.D., University of Vermont College of

Medicine.

This publication is not copyrighted. The Clearinghouse encourages users of

this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 04–4761

March 2004

[Top]

Digestive Diseases Home | Digestive Diseases A to Z | Statistics |

Clinical Trials | Additional Resources | Order Publications | About Us |

Contact Us | NIDDK Health Information

The NDDIC is a service of the National Institute of Diabetes and Digestive

and Kidney Diseases, National Institutes of Health.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Phone: 1–800–891–5389

Fax: 703–738–4929

Email: nddic@...

Privacy | Disclaimer | Accessibility

" and the beat goes on....... " Sonny Bono " It's not the years in your life that

count. It's the life in your years. " Abraham Lincoln

__________________________________________________

[Guest guest]

Email to a friend

Print this page

Also see:

Hepatitis Series

Home : Digestive Diseases A-Z List of Topics and Titles : Autoimmune

Hepatitis

Autoimmune Hepatitis

Autoimmune hepatitis affects

the liver.

Autoimmune hepatitis is a disease in which the body's immune system

attacks liver cells. This causes the liver to become inflamed (hepatitis).

Researchers think a genetic factor may predispose some people to

autoimmune diseases. About 70 percent of those with autoimmune hepatitis

are women, most between the ages of 15 and 40.

The disease is usually quite serious and, if not treated, gets worse over

time. It's usually chronic, meaning it can last for years, and can lead to

cirrhosis (scarring and hardening) of the liver and eventually liver

failure.

Autoimmune hepatitis is classified as either type I or II. Type I is the

most common form in North America. It occurs at any age and is more common

among women than men. About half of those with type I have other

autoimmune disorders, such as type 1 diabetes, proliferative

glomerulonephritis, thyroiditis, Graves' disease, Sjögren's syndrome,

autoimmune anemia, and ulcerative colitis. Type II autoimmune hepatitis is

less common, typically affecting girls ages 2 to 14, although adults can

have it too.

[Top]

Autoimmune Disease

One job of the immune system is to protect the body from viruses,

bacteria, and other living organisms. Usually, the immune system does not

react against the body's own cells. However, sometimes it mistakenly

attacks the cells it is supposed to protect. This response is called

autoimmunity. Researchers speculate that certain bacteria, viruses,

toxins, and drugs trigger an autoimmune response in people who are

genetically susceptible to developing an autoimmune disorder.

[Top]

Symptoms

Fatigue is probably the most common symptom of autoimmune hepatitis. Other

symptoms include

enlarged liver

jaundice

itching

skin rashes

joint pain

abdominal discomfort

fatigue

spider angiomas (abnormal blood vessels) on the skin

nausea

vomiting

loss of appetite

dark urine

pale or gray colored stools

People in advanced stages of the disease are more likely to have symptoms

such as fluid in the abdomen (ascites) or mental confusion. Women may stop

having menstrual periods.

Symptoms of autoimmune hepatitis range from mild to severe. Because severe

viral hepatitis or hepatitis caused by a drug—for example, certain

antibiotics—has the same symptoms, tests may be needed for an exact

diagnosis. Your doctor should also review and rule out all your medicines

before diagnosing autoimmune hepatitis.

[Top]

Diagnosis

Your doctor will make a diagnosis based on your symptoms, blood tests, and

liver biopsy.

Blood tests. A routine blood test for liver enzymes can help reveal a

pattern typical of hepatitis, but further tests, especially for

autoantibodies, are needed to diagnose autoimmune hepatitis. Antibodies

are proteins made by the immune system to fight off bacteria and viruses.

In autoimmune hepatitis, the immune system makes antinuclear antibodies

(ANA), antibodies against smooth muscle cells (SMA), or liver and kidney

microsomes (anti-LKM). The pattern and level of these antibodies help

define the type of autoimmune hepatitis (type I or type II).

Blood tests also help distinguish autoimmune hepatitis from viral

hepatitis (such as hepatitis B or C) or a metabolic disease (such as

's disease).

Liver biopsy. A tiny sample of your liver tissue, examined under a

microscope, can help your doctor accurately diagnose autoimmune hepatitis

and tell how serious it is. You will go to a hospital or outpatient

surgical facility for this procedure.

[Top]

Treatment

Treatment works best when autoimmune hepatitis is diagnosed early. With

proper treatment, autoimmune hepatitis can usually be controlled. In fact,

recent studies show that sustained response to treatment not only stops

the disease from getting worse, but also may actually reverse some of the

damage.

The primary treatment is medicine to suppress (slow down) an overactive

immune system.

Both types of autoimmune hepatitis are treated with daily doses of a

corticosteroid called prednisone. Your doctor may start you on a high dose

(20 to 60 mg per day) and lower the dose to 5 to 15 mg/day as the disease

is controlled. The goal is to find the lowest possible dose that will

control your disease.

Another medicine, azathioprine (Imuran) is also used to treat autoimmune

hepatitis. Like prednisone, azathioprine suppresses the immune system, but

in a different way. It helps lower the dose of prednisone needed, thereby

reducing its side effects. Your doctor may prescribe azathioprine, in

addition to prednisone, once your disease is under control.

Most people will need to take prednisone, with or without azathioprine,

for years. Some people take it for life. Corticosteroids may slow down the

disease, but everyone is different. In about one out of every three

people, treatment can eventually be stopped. After stopping, it is

important to carefully monitor your condition and promptly report any new

symptoms to your doctor because the disease may return and be even more

severe, especially during the first few months after stopping treatment.

In about 7 out of 10 people, the disease goes into remission, with a

lessening of severity of symptoms, within 2 years of starting treatment. A

portion of persons with a remission will see the disease return within 3

years, so treatment may be necessary on and off for years, if not for

life.

[Top]

Side Effects

Both prednisone and azathioprine have side effects. Because high doses of

prednisone are needed to control autoimmune hepatitis, managing side

effects is very important. However, most side effects appear only after a

long period of time.

Some possible side effects of prednisone are

weight gain

anxiety and confusion

thinning of the bones (osteoporosis)

thinning of the hair and skin

diabetes

high blood pressure

cataracts

glaucoma

Azathioprine can lower your white blood cell count and sometimes causes

nausea and poor appetite. Rare side effects are allergic reaction, liver

damage, and pancreatitis (inflammation of the pancreas gland with severe

stomach pain).

[Top]

Other Treatments

People who do not respond to standard immune therapy or who have severe

side effects may benefit from other immunosuppressive agents like

mycophenylate mofetil, cyclosporine or tacrolimus. People who progress to

end stage liver disease (liver failure) and/or cirrhosis may need a liver

transplant. Transplantation has a 1-year survival rate of 90 percent and a

5-year survival rate of 70 to 80 percent.

[Top]

Hope Through Research

Scientists are studying various aspects of autoimmune hepatitis to find

out who gets it and why and to discover better ways to treat it. Basic

research on the immune system will expand knowledge of autoimmune diseases

in general. Epidemiologic research will help doctors understand what

triggers autoimmune hepatitis in some people. Research on different

steroids, alternatives to steroids, and other immunosuppressants will

eventually lead to more effective treatments.

[Top]

Points to Remember

Autoimmune hepatitis is a long-term disease in which your body's immune

system attacks liver cells.

The disease is diagnosed using various blood tests and a liver biopsy.

With proper treatment, autoimmune hepatitis can usually be controlled. The

main treatment is medicine that suppresses the body's overactive immune

system.

[Top]

For More Information

American Liver Foundation (ALF)

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837),

1–888–4HEP–USA (443–7872),

or 212–668–1000

Fax: 212–483–8179

Email: info@...

Internet: www.liverfoundation.org

[Top]

The U.S. Government does not endorse or favor any specific commercial

product or company. Trade, proprietary, or company names appearing in this

document are used only because they are considered necessary in the

context of the information provided. If a product is not mentioned, this

does not mean or imply that the product is unsatisfactory.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Email: nddic@...

The National Digestive Diseases Information Clearinghouse (NDDIC) is a

service of the National Institute of Diabetes and Digestive and Kidney

Diseases (NIDDK). The NIDDK is part of the National Institutes of Health

of the U.S. Department of Health and Human Services. Established in 1980,

the Clearinghouse provides information about digestive diseases to people

with digestive disorders and to their families, health care professionals,

and the public. The NDDIC answers inquiries, develops and distributes

publications, and works closely with professional and patient

organizations and Government agencies to coordinate resources about

digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both

NIDDK scientists and outside experts. This publication was reviewed by

Willis Maddrey, M.D., University of Texas Southwestern Medical Center at

Dallas; and Krawitt, M.D., University of Vermont College of

Medicine.

This publication is not copyrighted. The Clearinghouse encourages users of

this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 04–4761

March 2004

[Top]

Digestive Diseases Home | Digestive Diseases A to Z | Statistics |

Clinical Trials | Additional Resources | Order Publications | About Us |

Contact Us | NIDDK Health Information

The NDDIC is a service of the National Institute of Diabetes and Digestive

and Kidney Diseases, National Institutes of Health.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Phone: 1–800–891–5389

Fax: 703–738–4929

Email: nddic@...

Privacy | Disclaimer | Accessibility

" and the beat goes on....... " Sonny Bono " It's not the years in your life that

count. It's the life in your years. " Abraham Lincoln

__________________________________________________