Autoimmune Hepatitis

Autoimmune hepatitis is a long-term disease in which the immune system attacks liver cells and causes ongoing inflammation. Type 1, the usual form in adults, is marked by antinuclear and smooth muscle antibodies. Type 2 is rarer and mainly affects children. It is not an infection and cannot be passed on.

Without treatment it can progress to cirrhosis and liver failure. With treatment, the great majority achieve remission and have a good long-term outlook. Most people need medication for many years, often for life, because relapse after stopping is common.

Symptoms

• Tiredness and a general feeling of being unwell
• Discomfort under the right ribs
• Joint aches
• Nausea and loss of appetite
• Jaundice with dark urine, which sometimes comes on suddenly like acute viral hepatitis
• Itching of the skin or skin rashes
• Absent periods
• No symptoms at all, with abnormal liver tests found by chance
• Swelling of the abdomen or legs when cirrhosis is already present

Causes and risk factors

The cause is a loss of immune tolerance to the body's own liver cells in genetically predisposed people, linked to certain HLA types. Triggers that have been reported include viral infections and some medicines, such as nitrofurantoin, minocycline and occasionally statins or biological drugs, as well as herbal products. About three quarters of patients are women. Other autoimmune conditions are common in patients and their relatives, including thyroid disease, type 1 diabetes, coeliac disease and ulcerative colitis. Overlap with primary biliary cholangitis or primary sclerosing cholangitis occurs.

How it is diagnosed

• Liver blood tests: ALT and AST are raised, often markedly, and bilirubin varies.
• Immunoglobulin G: Typically elevated. It falls with successful treatment.
• Autoantibodies: ANA and smooth muscle antibody in type 1. Anti-LKM1 and anti-LC1 in type 2. Anti-SLA is highly specific.
• Exclusion of other causes: Viral hepatitis serology, a review of medicines and herbal products, alcohol history, and tests for Wilson disease and fatty liver.
• Liver biopsy: Required in nearly all cases to confirm the diagnosis, which shows interface hepatitis with plasma cells, and to stage scarring.
• Elastography and ultrasound: Used to monitor fibrosis and, in cirrhosis, to screen for liver cancer every 6 months.

Treatment options

• Prednisolone: Induces remission over weeks to months. The dose is then reduced step by step.
• Azathioprine: Added after a few weeks so that the steroid dose can be lowered, and continued as maintenance. TPMT enzyme activity is checked first, and blood counts are monitored.
• Budesonide: An alternative steroid with fewer body-wide side effects, for patients without cirrhosis.
• Second-line medicines: Mycophenolate, tacrolimus or ciclosporin when standard treatment does not work or is not tolerated.
• Protection of bones and general health: Vitamin D and calcium, bone density scans, vaccinations and control of weight.
• Attempting withdrawal: Considered only after at least 2 to 3 years of completely normal blood tests, ideally with a repeat biopsy, and with close monitoring.
• Liver transplant: For acute liver failure or decompensated cirrhosis. The disease can recur in the new liver.

When it is urgent

Deepening jaundice with confusion, drowsiness, easy bruising or bleeding, vomiting blood, or a swollen abdomen with fever are signs of liver failure or its complications. Go to the nearest emergency department. While taking immunosuppressants, a high fever also needs prompt medical attention.

Travelling to Türkiye for treatment

Treatment depends on regular blood tests and dose adjustments over years, and that belongs with a liver specialist near you. Travel can help with the diagnostic stage, namely the antibody profile, a liver biopsy read by an experienced liver pathologist and elastography, or with a second opinion when remission has not been achieved. Allow 4 to 6 days when a biopsy is planned, since you should not fly for at least 24 to 48 hours after it. Transplantation in Türkiye requires a living related donor and approval by an ethics committee.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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