Understanding Autoimmune Liver Disease
Symptoms and Treatment of Hepatitis, Cirrhosis of the Liver
Nov 2, 2009
Liver diseases caused by autoimmune reactions in the body represent about 5% of all liver diseases. These include autoimmune hepatitis, primary biliary cirrhosis and sclerosing cholangitis. Autoimmune diseases are usually chronic and slow progressing, inflammatory diseases that may have varying symptoms in different individuals. They are also generally treatable with medication and surgery, especially if treatment is sought early in the progression of the disease.
Primary Autoimmune Liver Diseases
Autoimmune hepatitis is an inflammation of the hepatocytes or liver cells that has no known cause. It occurs more often in women than in men and occurs in all age groups and ethnicities. Patients may also have cirrhosis and lab blood tests determine high levels of liver enzymes called transaminases that indicate breakdown of liver cells. There may also be raised immunoglobulin G (IgG) levels.
Primary biliary cirrhosis is a slowly progressing disease and primarily affects middle aged women. Most patients diagnosed with this autoimmune liver disease have no symptoms while others have fatigue and pain and discomfort in the right upper side. Other autoimmune disorders that may trigger primary biliary cirrhosis include celiac disease, thyroid disease and scleroderma. Tests to diagnose this autoimmune disease include the presence of circulating anti-mitochondrial antibodies in 95% of patients.
Sclerosing cholangitis is a chronic liver disorder characterized by fibrosing inflammatory destruction of the biliary ducts inside and outside the liver. The average age of patients is 40 years and more men are affected than women. Almost 75% of individuals affected by sclerosing cholangitis also have inflammatory bowel disease, most commonly ulcerative colitis. Diagnosis of this disease is usually done by magnetic resonance imaging (MRI) which show strictures and beading of the bile ducts. Symptoms of sclerosing cholangitis include right upper side pain and discomfort, dark urine, pale stools and fever.
Diagnosis of autoimmune liver disease is usually by investigation of symptoms with autoantibody blood tests, liver biopsies and imaging of the liver.
Treatment For Autoimmune Liver Disease
Immunosuppression treatment with steroids and azathioprine have shown benefit in autoimmune liver diseases as well as other autoimmune disorders. Remission from the disease is indicated by normal levels of the enzyme transaminases and IgG in the blood. However, studies show that if treatment is stopped, about 80% of patients relapse, with 50% showing signs of liver disease within only six months.
Steroids are usually prescribed for one to two years after autoimmune liver disease is diagnosed while the medication azathioprine is usually given for two to five years. Treatment varies, however, depending on the individual’s health and progression of disease.
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