Autoimmune hepatitis

At Autoimmune hepatitis it is a rare disease of the liver. In the further course the organism develops antibodies which damage its own liver. If left untreated, the patient can die.

What is autoimmune hepatitis?

In autoimmune hepatitis, the body no longer accepts liver tissue as its own cells.
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Autoimmune hepatitis is not caused by viruses. Instead, it comes to a dysregulation, which leads to the fact that the body no longer sees certain cells as the body's own tissue. The process results in liver inflammation with a chronic course. About 80 percent of the patients are women.

Cases of illness occur particularly frequently in middle age. But the development in children cannot be ruled out either. While autoimmune hepatitis used to be one of the most common diseases, nowadays the number of diseases is 0.2 to 1.0 per 100,000 inhabitants. In addition to specific symptoms, there are also some that are less typical of liver diseases.

causes

The exact causes of autoimmune hepatitis have not yet been fully researched. Ultimately, the body no longer accepts liver tissue as its own cells. As with every occurrence of foreign bodies, it produces antibodies to combat the supposed pests.

In this way, the organism would normally like to protect itself from intruders and pathogens. The destruction of healthy tissue, however, leads to chronic inflammation, which in the long term is associated with a loss of function of the organ.

It is not yet known why the dysregulation of the immune system occurs. Scientists assume that some patients have genetic predispositions. In addition to this basic predisposition, there should be factors that are responsible for the onset of the disease.

These include, for example, pregnancies, infections or exposure to toxins. Certain drugs, toxins and infections caused by viruses or bacteria are also suspected.

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Symptoms, ailments & signs

The symptoms of autoimmune hepatitis are for the most part considered uncharacteristic. Symptoms such as tiredness, decreased performance, nausea or a slight discoloration of the skin that turns yellow. Some patients complain of pain in the upper right abdomen or an increase in temperature. Often, however, these cannot be assigned to any physical symptoms, which is why autoimmune hepatitis is not infrequently diagnosed relatively late.

Some patients generally have no symptoms or symptoms. Instead, the disease only becomes noticeable as it progresses. About 30 to 50 percent of those affected also have other diseases that are related to the dysregulation of the immune system. Other organs are attacked by the body, colon inflammation, thyroid inflammation or rheumatoid arthritis occur.

In some cases, autoimmune hepatitis can rapidly develop into liver failure. Subsequent treatment therefore not only has to deal with the primary autoimmune hepatitis, but also with the diseases that have developed from it.

Diagnosis & course

The time at which the diagnosis is made is responsible for the further course of the disease. If untreated, cirrhosis of the liver cannot be ruled out. In order to establish the diagnosis, laboratory tests of the blood are mainly carried out. This contains information on a possible infection by viruses and the level of antibodies.

As soon as autoimmune hepatitis is suspected, it is verified or falsified by taking a tissue sample from the liver. The operation takes place under local anesthesia. The tissue can then be examined in the laboratory. If the disease is discovered and treated early on, there are various therapeutic approaches to which the body usually reacts well. However, if left untreated, the chances of recovery are slim.

Complications

Autoimmune hepatitis can progressively destroy the liver, which can result in liver failure (liver failure). Liver failure is initially characterized by a reduced synthesis capacity. As a result, fewer clotting proteins are made, so bleeding time is increased.

This can lead to bleeding, especially in the gastrointestinal tract. In addition, edema and accumulation of water in the abdominal area, the ascites, develop. In addition, the sugar production is disturbed, so that the body is hypoglycemic, which can lead to a coma. In addition, the liver can no longer properly detoxify toxins that accumulate in the body, the nerve toxin ammonia in particular should be mentioned here.

The ammonia can cross the blood-brain barrier and lead to hepatic encephalopathy, which can also end in a coma and in the worst case, death of the patient. In addition, autoimmune hepatitis can develop into scarring of the liver tissue, cirrhosis of the liver, which has similar complications. Cirrhosis of the liver creates collateral circulation and the affected person develops hemorrhoids and varicose veins in the stomach and esophagus.

In addition, more blood is broken down in the spleen, so that it enlarges and causes corresponding pain. As a result of the hepatorenal or hepatopulmonary syndrome, the kidneys or lungs can fail due to liver cirrhosis. The likelihood of developing liver cancer over time is also increased.

When should you go to the doctor?

With autoimmune hepatitis, it is almost essential to have regular check-ups and to subject the condition of the liver to detailed medical examinations. Autoimmune hepatitis damages the liver. Therefore it must be determined to what extent the drugs used are effective and whether it is necessary to initiate other or additional treatment measures.

If symptoms arise between the check-up appointments, those affected should not be shy and contact the doctor before the next routine examination. These specific complaints include, for example, upper abdominal pain, colicky pain, dark urine combined with pale stool, and the effects of jaundice in the form of discoloration of the skin and / or eyes.

Severe courses and effects of the autoimmune disease make more frequent visits to the doctor necessary at shorter intervals. The check-ups should be strictly observed by the patient in any case, since the illness can also lead to relapsing phases, which are then recognized in good time.

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Treatment & Therapy

Therapy consists of either cortisone treatment or immunosuppressive drugs. A combination of the drugs is used in some patients. A gentler method of treating the symptoms, for example through alternative healing methods, is not possible. Immunosuppressants ensure that the immune system is suppressed.

An increased dose of immunosuppressants usually allows a reduction in cortisone.Usually, the medication is set very high at the beginning and then regularly reduced until the patient has reached his individually appropriate dose. Treatment with cortisone alone is often sought, especially for women who want to have children. However, cortisone has a relatively high number of side effects. This can lead to acne, full moon face, stomach ulcers, osteoporosis and high blood pressure.

Many of the side effects develop mainly due to the long duration of use. Treatment with cortisone should continue for at least two years in the presence of autoimmune hepatitis. Only after this point in time is it advisable to try to reduce or discontinue the medication under medical supervision. Regular medical checks are inevitable here. The optimal drug treatment can ensure that the autoimmune hepatitis is stopped and is no longer active.

In this way, it is possible for patients with the disease to achieve a normal life expectancy. If cirrhosis of the liver has already developed due to autoimmune hepatitis, the only option is often a transplant with a donor organ. A transplant can potentially lead to further complications and worsen the prognosis. This is why quick action is required when the diagnosis is recognized.

Outlook & forecast

The factors that significantly increase the risk of an unfavorable course of autoimmune hepatitis include late diagnosis, postponed treatment, and high inflammatory activity. Unfortunately, the prognosis for a child or adolescent organism is usually bleak due to the higher activity of the young immune system.

But the fight is worth it. Just a few decades ago, around 90 percent of those affected died within 10 years. The introduction of immunosuppressants into everyday clinical practice has turned the statistics into the opposite: now the survivors make up the 90 percent. Autoimmune hepatitis can be monitored using biochemical and histological controls. The formation of bridge necrosis should be resisted, as their encroachment on hepatic veins is extremely risky.

If cirrhosis of the liver is avoided, the patient is also protected against the development of liver cell carcinoma. Thanks to immunosuppressive therapy, liver cirrhosis occurs significantly less often, and the course of the disease improves in half of those affected. Liver transplantation can be compared with drug therapy - it guarantees a good prognosis of at least five years in over 90 percent of cases.

Unfortunately, autoimmune hepatitis only allows secondary prophylaxis through antibody and immunoglobulin control. Patients should take care of themselves physically and emotionally, adhere to a light diet and reduce their medication intake to the bare minimum.

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prevention

Because the exact causes that lead to the development of autoimmune hepatitis are not yet known, preventive treatment is not possible. A healthy lifestyle with plenty of exercise, a conscious diet, and limiting nicotine and alcohol may prove beneficial, but it may not prevent autoimmune hepatitis either.

Aftercare

A causal healing of the autoimmune hepatitis is excluded. Follow-up care cannot therefore aim to prevent the disease from recurring. Instead, it is about making everyday life symptom-free and preventing complications. Patients regularly take part in follow-up examinations. The disease can be diagnosed with a blood test.

In order to keep an eye on the expansion and structure of the liver, it is not uncommon for an ultrasound examination to follow. Patients have a responsibility to ensure that their condition does not get worse. The prescribed immunosuppressants should be taken regularly. In addition, there are possibilities in everyday life to protect the liver.

Those affected should avoid alcohol and lose weight sustainably. Adequate physical exercise is also necessary. You can get vaccinated against certain forms of hepatitis. However, this preventive measure is not available for the autoimmune disease. The success of the lengthy treatment depends on the starting time.

The earlier patients start therapy, the more symptom-free life becomes. If complications arise, the service life is automatically greatly reduced. The negative consequences include the restructuring of the liver and restrictions in the detoxification function. As the symptoms progress consistently, inpatient accommodation becomes necessary.

You can do that yourself

In the case of autoimmune hepatitis, in addition to medical treatment, a healthy lifestyle is of great importance. Because this can both improve your well-being and prevent impending deficiency symptoms. Those affected should eat a balanced and healthy diet and exercise regularly. In addition, it is important to reduce any overweight and prevent underweight. A vegan lifestyle also helps with autoimmune hepatitis to improve the transaminases (liver values).

Anyone who suffers from autoimmune hepatitis should also avoid substances that are harmful to the liver, especially alcohol. In contrast, studies from recent years suggest that coffee protects the liver. As research results show, coffee helps prevent liver cancer in a chronically ill liver. While taking a cortisone supplement such as prednisolone, those affected should consume vitamin D and calcium. These prevent cortisone-related bone loss.

In order to protect the liver and to achieve regeneration, herbal preparations, including milk thistle, liquorice, artichoke, schizandrin C (DDB) or homeopathic active ingredients such as liver organ extracts are used. In addition, amino acids and vital substances strengthen the affected organ.

Therapeutic fasting can also have a positive effect on autoimmune hepatitis. However, this must not be done if there is already cirrhosis of the liver. Basically: Supplementary therapies, whether naturopathic or homeopathic, should always be discussed with the treating doctor and carried out under supervision.