Autoimmune hepatitis is a dangerous disease that is accompanied by chronic inflammation and liver damage. This disease is more often diagnosed in people of young and mature age. If untreated or too late, the prognosis for patients is poor. That is why it is worth familiarizing yourself with additional information.
So what is a pathology? What are the reasons for its occurrence? What signs are worth paying attention to? What autoimmune hepatitis tests should I take? Are there really effective therapies? What are the prognoses for patients? The answers to these questions are sought by many readers.
What is a pathology?
Autoimmune hepatitis (according to the ICD - K73.2) is a disease that is accompanied by a chronic inflammatory process in the tissues of the liver. This is an immune-dependent pathology - for one reason or another, the human body begins to produce specific antibodies that attack the cells of its own liver.
This disease is considered rare - for every million people there are no more than 50-200 patients with this diagnosis. Most often, people aged 10 to 30 get sick (autoimmune hepatitis in children is also possible) and from 50 to 70 years. Women are more prone to this disease.
By the way, for the first time the symptoms of progressive hepatitis, which invariably ended in cirrhosis, were described by D. Waldenstrom in 1950. In 1956, during studies in the blood of patients, antinuclear bodies were discovered that confirmed the autoimmune origin of the disease. At that time, the disease was given the name "lupoid hepatitis." The term “autoimmune hepatitis” was introduced into the international nomenclature in 1965.
The main causes of the development of the disease
Autoimmune hepatitis is associated with inadequate activity of the human immune system, which, in fact, is evidenced by the name of the pathology. Antibody attack leads to inflammatory-necrotic changes in the structures of the liver.
During the study, several types of antibodies were found in the blood of patients. Nevertheless, the main role in the development of the disease is played by two compounds:
- SMA antibodies (anti-smooth muscle), which destroy the smallest structures of smooth muscle cells;
- ANA antibodies (antinuclear) have a detrimental effect on DNA and proteins of cell nuclei.
Unfortunately, to date, the exact causes of autoimmune reactions are unknown. There are suggestions that viruses that penetrate the human body, in particular viruses of various forms of hepatitis, herpes simplex virus, HIV infection, Epstein-Barr virus, can activate this disease.
Risk factors include the activity of salmonella and yeast in the human body. There is a hereditary predisposition. Thanks to scientific research, it was found that the beginning of the autoimmune process is sometimes associated with taking drugs such as Oxyphenisatin, Monocycline, Isoniazid, and Diclofenac.
Autoimmune hepatitis: symptoms
Unfortunately, there are no specific signs, the appearance of which could confirm the presence of an autoimmune form of hepatitis. The clinical picture is blurry. The following symptoms may occur:
- general deterioration of the patient's well-being;
- persistent drowsiness;
- fatigue, decreased performance;
- a person gets tired even of minimal physical exertion, which in the past the body endured quite normally;
- the appearance of fullness, constant severity in the right hypochondrium;
- sclera of the eyes and skin are painted yellow (jaundice can be either permanent or transient);
- the patient’s urine becomes much darker;
- periodic increases in body temperature are observed (fever disappears as quickly as it appears);
- joint pain, muscle aches;
- impaired appetite and associated weight loss;
- integuments suffer from liver dysfunctions - patients complain of irritating skin itching, burning, redness;
- in women, menstrual irregularities are possible (sometimes menstruation ceases altogether);
- the appearance of spider veins and small, point hemorrhages;
- the palms of patients often acquire a reddish tint;
- the list of symptoms includes spontaneous attacks of tachycardia.
In the presence of such symptoms, it is extremely important to consult a specialist. The sooner the disease is detected, the higher the likelihood of a favorable outcome. Unfortunately, the intensity of the symptoms increases gradually, so patients often consult a doctor already at the stage of cirrhosis.
Extrahepatic manifestations
Autoimmune hepatitis is a systemic disease. Often, patients are diagnosed with not only inflammatory-necrotic changes in the liver, but also other pathologies, including:
- systemic lupus erythematosus ;
- rheumatoid arthritis of varying severity;
- some forms of thyroiditis;
- hemolytic anemia;
- vitiligo (the disappearance of skin pigmentation);
- vasculitis;
- bronchial asthma;
- insulin-dependent form of diabetes;
- poliomyositis;
- baldness, both in men and women;
- scleroderma;
- Raynaud's syndrome;
- fibrosing alveolitis;
- autoimmune form of thrombocytopenia.
In the process of diagnosis, it is extremely important to determine what other organs have suffered from auto-aggression of their own antibodies.
The main types of disease
There are many classification systems for this pathology. Depending on which antibodies can be isolated from the patient’s blood, three types of autoimmune hepatitis are distinguished.
- The most common is the first type of disease, which, incidentally, is most often recorded in women. Both antinuclear and anti-smooth muscle antibodies are present in the blood. The disease is sluggish and responds well to immunosuppressive therapy.
- Hepatitis of the second type is most often found in children aged 2 to 14 years. The disease progresses rapidly, and the forecasts are unfavorable. According to statistics, 40-70% of patients at the time of diagnosis already have cirrhosis at one stage or another of development. Extrahepatic manifestations of the disease are recorded more often than with hepatitis of the first type. The disease is more resistant to drug treatment.
- The third type of disease is characterized by the presence of antibodies to the hepatic antigen in the blood. According to the clinical picture, it is similar to hepatitis of the first type.
What complications can a disease cause?
Autoimmune hepatitis of the liver is an extremely dangerous pathology. If untreated, the disease inevitably ends with complications. Their list is quite large:
- progressive liver failure, which can lead to the development of so-called hepatic encephalopathy (accompanied by toxic damage to the nervous system, which leads to the development of depressive states, decreased intelligence, personality changes, etc.);
- ascites (a pathology in which fluid accumulates in the free abdominal cavity);
- varicose veins of the esophagus with their further damage and massive bleeding;
- cirrhosis of the liver.
That is why the patient should regularly take tests and be monitored by a doctor - the only way to notice the onset of deterioration in time.
Diagnostic measures
If the patient has the above symptoms, the doctor will prescribe additional studies. Autoimmune hepatitis can be talked about if:
- the patient’s history does not contain information on alcohol abuse, blood transfusions, or taking medications that negatively affect liver function;
- an elevated level of immunoglobulins is detected in the blood (at least 1.5 times higher than normal);
- in the study of blood serum, no markers of active viral diseases (cytomegalovirus, hepatitis A, B and C) were found;
- found elevated blood levels of SMA and ANA antibodies.
Patients must be sent for an ultrasound of internal organs, as well as magnetic resonance imaging and computed tomography. These procedures provide the doctor with information about the size of the liver, changes in its structure. It is also possible to confirm the presence of Wilson’s disease, chronic viral hepatitis, fatty liver, cirrhosis, cholangitis and some other diseases.
Conservative treatment
Depending on the results of the tests and the general condition of the patient, the doctor will draw up a therapy regimen. How is autoimmune hepatitis treated? Clinical recommendations are as follows.
- A mandatory part of treatment is the administration of glucocorticosteroids. As a rule, Prednisone is used. From 40 to 80 mg of this drug is administered to patients depending on body weight. The course lasts two weeks, after which laboratory tests are performed. If the patient's condition has improved, the dose of Prednisolone is gradually reduced to 10–20 mg per day.
- Patients also take cytotoxic drugs that inhibit the activity of the immune system. Effective is Azathioprine. Patients take three tablets per day. Therapy lasts from 2 to 6 months.
- Urosdeoxycholic acid is also included in the treatment regimen. This substance has a beneficial effect on the liver, accelerates the regeneration of hepatocytes.
- Of course, symptomatic treatment is also carried out . For example, in the presence of ascites and edema, patients are prescribed Furosemide. This medicine is intended for short-term use, as it removes potassium from the body.
- If there is bleeding gums, pinpoint subcutaneous hemorrhage, the appearance of spider veins, then doctors recommend taking the “Vikasola” tablet three times a day.
- The drug “Riabal” helps to cope with pain and discomfort.
It is worth noting that anti-inflammatory and immunosuppressive therapy lasts at least 1-2 years. The patient is regularly tested - so the doctor can evaluate the effect of the treatment, to detect deterioration in time. If it was possible to achieve remission, the scheme and schedule of taking the drugs can be slightly changed. According to statistics, in 80% of cases after a complete withdrawal of drugs, patients develop a relapse. Only a few patients with anti-inflammatory therapy can achieve a stable remission. But even if the therapy ended successfully, a person should still constantly be registered with a doctor.
Diet for hepatitis
Treatment of such a disease necessarily includes an appropriate diet. A proper diet will help relieve stress from the liver. What does nutrition look like with a disease such as autoimmune hepatitis? Recommendations are as follows:
- fractional nutrition is the ideal option (the daily food intake is divided into 5-7 meals);
- you need to limit the amount of salt to 5 g per day;
- per day, doctors recommend drinking at least 1.5 liters of water;
- alcoholic drinks are strictly prohibited;
- you need to abandon products that contain cocoa, as well as carbonated drinks, coffee, legumes, mushrooms, spices, nuts, citrus fruits, whole milk, honey;
- allowed to eat cereals, low-fat meats and fish, fruits and vegetables;
- spicy, fried, fatty and canned foods are contraindicated;
- dishes need to be steamed, boiled or baked in the oven.
Surgical intervention
Using conservative methods, you can stop the symptoms, inhibit the inflammatory process and the further development of hepatitis. Nevertheless, surgical treatment of autoimmune hepatitis is by far the only effective way to eliminate this pathology. The essence of therapy in this case is the transplantation of a new liver to the patient.
Of course, the procedure involves a lot of difficulties. Finding a suitable donor is not so easy, sometimes this process takes several years. Moreover, the operation is expensive, and not every surgeon is qualified to carry out the transplant.
This is the only way to get rid of a disease such as autoimmune hepatitis. Cured patients should adhere to certain recommendations, eat right and take appropriate medications.
Unfortunately, difficulties can occur even after transplantation. In particular, there is a risk of organ rejection. Transplanted liver for one reason or another may not work properly, which leads to liver failure. In addition, the medications that the patient takes suppresses the activity of the immune system (this helps prevent rejection), which is why people suffer infections much harder - a common cold can result in pneumonia, meningitis or sepsis.
Home Remedies
You already know what autoimmune hepatitis is. Causes, symptoms, conservative treatment are all important points. But many patients are interested in questions about whether home remedies can be added to the treatment regimen. Traditional medicine offers various means to improve liver function.
- Oat is considered beneficial, since the extract of this plant helps to restore hepatocytes. To prepare the medicine, you will need 350 g of unrefined grains, which must be poured with three liters of water. The mixture must be brought to a boil, after which it is simmered over a small fire for three hours. After the broth has cooled, it must be filtered. You need to take 150 ml twice a day (preferably 20-30 minutes before meals) for 2-3 weeks.
- Vegetable juices also have a positive effect on the liver. For example, you can drink radish and beet juices mixed in equal amounts (not more than one glass of the mixture per day). It helps juice (or puree) from fresh pumpkin, as well as juice from fresh or pickled cabbage.
- In the treatment of hepatitis and other liver diseases, beekeeping products are widely used, in particular honey, propolis, royal jelly.
It is worthwhile to understand that autoimmune hepatitis is a serious disease, so you should not experiment with medicines. Before using any home remedies, you should consult your doctor.
Autoimmune hepatitis: patient predictions
In this case, much depends on the therapy. If the patient has not received adequate medical care, then chronic autoimmune hepatitis will inevitably lead to cirrhosis, the development of liver failure and death of the patient.
Properly selected and started treatment on time gives patients a chance - in 80% of cases, patients manage to recover at least partially and live for at least 20 years. If the inflammatory process is associated with cirrhosis, then the prognosis, alas, is not so favorable - 80% of patients die within the next 2-5 years. Liver transplantation allows achieving stable remission (the prognosis for patients for the next five years is quite favorable).