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Autoimmune hepatitis

Published by Bupa's health information team, May 2009.

This factsheet is for people who have autoimmune hepatitis, or who would like information about it.

Autoimmune hepatitis is a condition where your immune system attacks your liver cells by mistake, causing inflammation of your liver.

What is autoimmune hepatitis?
Types of autoimmune hepatitis
Symptoms of autoimmune hepatitis
Complications of autoimmune hepatitis
Causes of autoimmune hepatitis
Diagnosis of autoimmune hepatitis
Treatment of autoimmune hepatitis
Living with autoimmune hepatitis
Questions and answers
Related topics
Further information
Sources

What is autoimmune hepatitis?

Hepatitis means inflammation of your liver. If inflammation lasts for more than six months, it's known as chronic hepatitis. Autoimmune hepatitis is a type of chronic hepatitis.

Your body's immune system normally produces antibodies to fight off infections caused by bacteria and viruses. An autoimmune condition occurs when your immune system produces antibodies that attack your own body by mistake. Autoimmune hepatitis happens when your immune system starts to attack your liver cells, causing inflammation of your liver.

Autoimmune hepatitis is a fairly rare condition. It affects both men and women, but it's more common in women.

Types of autoimmune hepatitis

There are three types of autoimmune hepatitis. These are based on the type of autoantibodies that are circulating in your bloodstream. Autoantibodies are the proteins made by your immune system that attack your liver by mistake.

Type I is the most common type of autoimmune hepatitis. It affects people of all ages, but is most common in young women.
Type II usually occurs in children.
Type III mainly affects adults.

Symptoms of autoimmune hepatitis

Many people with autoimmune hepatitis have no symptoms. For others, symptoms may include:

fatigue (tiredness)
lack of energy
joint pains, especially in the mornings
generally feeling unwell

Other, less common, symptoms are:

nausea
decreased appetite and weight loss
stomach pains and bloating
indigestion
bruising
jaundice - yellowing of your skin and the whites of your eyes, and darkening of your urine
abnormal blood vessels on your skin, especially on your face, arms and chest

Complications of autoimmune hepatitis

Sometimes autoimmune hepatitis can develop into cirrhosis. Cirrhosis is a condition where your normal liver tissue is replaced with scar tissue, meaning your liver can't function properly. In the early stages of cirrhosis, you may not have any symptoms. If it's more severe you may experience weakness, nausea, swelling of your abdomen (tummy), vomiting blood and weight loss. If it's not treated, cirrhosis will eventually cause your liver to fail.

Causes of autoimmune hepatitis

The exact reasons why you may develop autoimmune hepatitis aren't fully understood at present. It's thought that some of your white blood cells, called lymphocytes, try to destroy your liver cells as though they are 'foreign' to you.

It's thought that susceptibility to autoimmune diseases, such as autoimmune hepatitis, is inherited from your parents (genetic). People with autoimmune hepatitis often have other autoimmune diseases, including rheumatoid arthritis, thyroid disease, vitamin B12 deficiency and vitiligo (a condition causing pale patches on your skin).

Diagnosis of autoimmune hepatitis

Your GP will ask about your symptoms and give you a physical examination. You will also need to have a blood test and usually a liver biopsy.

You will have a special type of blood test, called a liver function test. A doctor will take a small sample of blood from a vein in your arm, using a syringe. It will be sent to a laboratory, where the levels of certain substances in your blood will be measured. The levels of these substances can show how inflamed your liver is, and whether it's damaged.

If your GP thinks you have autoimmune hepatitis, he or she will refer you to a specialist. This will be a hepatologist (a doctor who specialises in conditions affecting the liver) or a gastroenterologist (a doctor who specialises in conditions affecting your digestive system).

If you have been referred to a specialist, he or she will usually carry out a liver biopsy. This means that a sample of your liver tissue will be removed and examined. You will be given an injection of local anaesthetic into your lower chest to numb the area, so you won't feel any pain. Your doctor will insert a long, thin, hollow needle will through your skin and into your liver, and a small piece of your liver tissue will be removed. The tissue sample will be sent to a laboratory and examined.

You may need to stay in hospital overnight after your biopsy. You should arrange for a friend or relative to pick you up from the hospital so that you don't have to drive or travel on your own.

Treatment of autoimmune hepatitis

Medicines

Autoimmune hepatitis is treated with medication that suppresses your immune system and prevents it from attacking your liver. This is called immunosuppression therapy. Your doctor will prescribe you a type of drug called a corticosteroid (usually prednisolone). This will reduce the inflammation in your liver and your symptoms should improve.

You will usually need to take a high dose of corticosteroids to begin with. Your doctor will reduce the dose once your liver is less inflamed. You may be prescribed another immunosuppressant drug called azathioprine, to take as well as the corticosteroids. Taking azathioprine will allow the dose of corticosteroids to be reduced. Eventually you may be able to stop taking the corticosteroids completely and just take azathioprine.

Immunosuppression therapy can have side-effects. Side-effects usually occur if you have been taking high doses of corticosteroids for a long time.

Side-effects of corticosteroids can include:

increased appetite
weight gain
diabetes
fluid retention
indigestion
bruising more easily
thinning of your skin and bones - you may need to take some additional medication to reduce the risk of bone loss
glaucoma and cataracts may also be made worse by autoimmune hepatitis

Side-effects of azathioprine include:

nausea and vomiting
diarrhoea
dizziness
rash
fever
suppression of your bone marrow, causing anaemia
rarely, inflammation of your pancreas and jaundice

If you're taking azathioprine you will need to have regular blood tests so that your doctor can check for these side-effects.

Most people with autoimmune hepatitis need to take medication long term. You should never stop taking your medication without speaking to your doctor first.

Surgery

If immunosuppressant therapy hasn't been effective, or you develop advanced cirrhosis and your liver is severely damaged, you may need to have a liver transplant. This is a major operation to remove your liver and replace it with a healthy liver from an organ donor.

After a liver transplant, you should see a great improvement in your symptoms. However you will need to take medication for the rest of your life to prevent your body rejecting the new liver.

Living with autoimmune hepatitis

Immunosuppression therapy can increase your appetite, so you may put on weight. It's important to eat a healthy and balanced diet. If you're putting on weight, try to reduce the amount of fatty and sugary foods you eat. If you're concerned about your weight gain, ask your GP for advice.

You may find you need to pace yourself to preserve your energy. Doing some light exercise every day, such as walking or swimming, will help to keep your muscles in good condition. Speak to your GP before you do any strenuous activity.

Alcohol

If you have autoimmune hepatitis, try not to drink alcohol. Alcohol can speed up the effects of liver disease or make them worse. If you do choose to drink, stay within the guideline amounts. The Department of Health recommend that women shouldn't drink more than two to three units of alcohol per day, and men should drink no more than three to four units per day.

If you have developed cirrhosis as a result of autoimmune hepatitis, don't drink alcohol at all.