Autoimmune Hepatitis (AIH)
What is autoimmune hepatitis?
Autoimmune hepatitis (AIH) is a disease that causes the body’s immune system to attack healthy liver cells, resulting in liver injury and scarring. AIH can be serious and if not treated, can cause cirrhosis or liver failure.
What causes autoimmune hepatitis?
Certain genetic factors can increase the risk developing an autoimmune disease like AIH. Diseases like AIH are also often triggered by environmental factors such as an infection. A viral infection, for example, can initiate a liver injury and result in an immune-mediated attack on the liver.
In addition to infections triggering the immune system to attack the liver, people with AIH may have also recently used certain medicines, or have a family history of other autoimmune disorders. These can include celiac disease, Crohn’s disease, ulcerative colitis, type 1 diabetes, rheumatoid arthritis, primary sclerosing cholangitis, thyroid disease or lupus erythematosus.
Who gets autoimmune hepatitis?
AIH affects all ages, genders and ethnicities. However, it is more common in girls than it is in boys. Family history of another autoimmune disease also increases chances of having AIH, which suggests there is an underlying genetic risk as well.
What are the signs and symptoms of autoimmune hepatitis?
Many patients with AIH have no symptoms and the disease is discovered when liver tests are checked for another reason. However, the most common symptoms that show up early can include:
- Feeling tired (fatigue)
- Joint pain
- Enlarged liver
- Abdominal (belly) discomfort, pain or swelling
- Yellow skin and eyes (jaundice)
- Dark-colored urine
Sometimes AIH comes on quickly, in which case, symptoms can include:
- Ascites (fluid in the belly)
- Blood doesn’t clot effectively (leading to prolonged bleeding)
- Pale-colored stool
- Mental confusion
- Enlarged spleen
- Acute hepatitis or liver failure
What tests are used to diagnose autoimmune hepatitis?
AIH is diagnosed based on liver tests, antibody tests and a liver biopsy. Because AIH can be confused with other illnesses, the testing to diagnose it can be quite extensive.
Blood testing is needed to check liver function and to rule out viral hepatitis (hepatitis A, B, C or mononucleosis), as well as metabolic causes of hepatitis like alpha-1 anti-trypsin deficiency and Wilson copper storage disease. The main tests for a diagnosis are an antibody blood test and a liver biopsy. A liver biopsy involves taking out a small piece of liver tissue and sending it to the laboratory for testing.
What to expect from a liver biopsy?
The specialists in our Pediatric Liver Center are highly skilled and perform liver biopsies on a weekly basis. This is an outpatient procedure performed with anesthesia, so that your child will not experience any pain during the procedure.
Why choose us for managing autoimmune hepatitis?
Our Pediatric Liver Center is one of the largest in the country and provides a fast and targeted approach to accurately diagnosing your child’s liver disease. A fast and accurate diagnosis is vital to retaining as much liver function as possible. The longer the AIH is allowed to go untreated, the greater the risk is of developing cirrhosis or liver failure.
How is autoimmune hepatitis treated?
The treatment of AIH incudes the use of medications that stop the immune system from attacking the liver. These are effective in over 90% of cases of AIH in children.
The medications used to treat AIH include:
- Corticosteroids are medicines that bring down swelling (anti-inflammatory) and slow down the immune system. The most commonly used corticosteroid is Prednisone. Budesonide can be used in place of prednisone in mild cases of AIH. Budesonide causes fewer side effects than prednisone.
- Immune system suppressants are medicines that decrease the response of the immune system and block the immune reaction that causes swelling in the liver. Azathioprine (Imuran) is often used. Those taking this medicine should have routine blood tests to check their complete blood cell counts, liver tests and azathioprine metabolite levels.
Why choose us for treatment of autoimmune hepatitis?
Our Pediatric Liver Center is at the forefront in caring for children with AIH. We have done research in this field and have been key contributors to the national guidelines for the management of AIH in children. Our doctors are also very active in the American Association for the Study of Liver Diseases and have helped to improve treatment and provide innovate new methods of care.
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