Autoimmune Hepatitis: Causes, Symptoms, Treatment and Cost

Autoimmune hepatitis (AIH) is a chronic, progressive liver disease in which the body's immune system attacks the liver, causing inflammation and damage.

There are two forms of autoimmune hepatitis: type 1 and type 2.

• Type 1 autoimmune hepatitis: Type 1 autoimmune hepatitis (AIH-1) is characterized by high levels of immunoglobulin G (IgG) autoantibodies, which target the body's own cells and cause inflammation of the liver. It is most common in young women.
• Type 2 autoimmune hepatitis: Type 2 autoimmune hepatitis (AIH-2) occurs most often in children, and is characterized by the presence of antinuclear antibodies (ANA) and antismooth muscle antibodies (ASMA).

• Drug-induced: Autoimmune hepatitis can be triggered by certain medications such as minocycline, nitrofurantoin, and phenytoin.
• Infection-induced: Certain viral infections such as Hepatitis C, Hepatitis B, and Epstein-Barr virus can cause autoimmunity in the liver.
• Genetic: A person’s genetic makeup can play a role in the development of autoimmune hepatitis, such as having a family history of the condition or having certain gene mutations that make them more susceptible to developing it.
• Environmental: Exposure to environmental toxins has been linked to autoimmune hepatitis in some cases.

Autoimmune hepatitis can cause a variety of symptoms, such as:

• Fatigue
• Unexplained fever
• Abdominal pain
• Joint pain or stiffness
• Nausea and vomiting
• Jaundice
• Dark urine
• Loss of appetite
• Weight loss
• Itching.

• Avoid known triggers, such as medicines, alcohol, or viral infections.
• Eat a balanced diet that is low in sugar and saturated fat.
• Maintain a regular exercise routine.
• Maintain a healthy body weight.
• Lower your anxiety levels.
• Get regular checkups and follow a recommended treatment plan from your doctor.

• Liver Function Tests: A series of blood tests to measure the levels of certain enzymes and proteins present in the liver, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Unusually elevated levels of these enzymes may point to liver damage.
• Antinuclear Antibody Test: A blood test that looks for antinuclear antibodies (ANA), which are proteins produced by the body’s immune system that attack its own cells. ANA can be found in people with autoimmune diseases, including autoimmune hepatitis.
• Immunoglobulin Test: A blood test that looks for immunoglobulins, which are proteins produced by the body’s immune system to fight off infections and other foreign substances. High levels of immunoglobulins may be seen in people with autoimmune hepatitis.
• Ultrasound: Ultrasound imaging is a diagnostic procedure that employs sound waves to generate an image of internal organs, including the liver. An ultrasound can help diagnose autoimmune hepatitis and detect any signs of inflammation or scarring in the liver.
• Liver Biopsy: A procedure where a small sample of tissue is taken from the liver and examined under a microscope for signs of inflammation or scarring caused by autoimmune hepatitis.

• Infections: Autoimmune hepatitis can make the body more vulnerable to infections.
• Liver failure: Long-term, untreated autoimmune hepatitis can result in permanent liver damage and eventually, cirrhosis or a complete shut-down of the organ's functioning (liver failure).
• Cancer: Having autoimmune hepatitis increases the risk of liver cancer, due to the damage caused from long-term inflammation and tissue scarring.
• Other autoimmune diseases: People with autoimmune hepatitis may have an increased risk for other autoimmune diseases such as rheumatoid arthritis and lupus.
• Liver transplant: In severe cases, people with autoimmune hepatitis may require a liver transplant for survival.

• Boil one teaspoon of turmeric in a glass of milk and drink it daily.
• Add some pasanbela leaves, neem leaves and basil leaves in buttermilk, boil it, cool it and drink this North Indian way of treating autoimmune hepatitis.
• Fry some ginger, cumin seeds and fenugreek seeds with asafoetida in ghee/ healthy oil and intake the mixture twice daily for best results.
• Tridoshic fruits such as apples, pears are effective for treating autoimmune hepatitis and should be consumed regularly.
• Include amla powder or grinded dried amla in your diet for natural detoxification effects on the body which is beneficial for controlling Autoimmune Hepatitis Symptoms.

• Adopt a nutritious diet: Be sure to eat enough fruits and vegetables, whole grains, lean proteins, low-fat dairy, and healthy fats.
• Drink plenty of fluids: Aim for 6 to 8 glasses of water per day, as well as herbal teas or low-sugar fruit juices.
• Include foods that are high in antioxidant vitamins: Examples include bell peppers, dark leafy greens, cruciferous vegetables (like broccoli and cauliflower), citrus fruits and carrots.

• Steer clear of unhealthy and processed foods, such as fried foods, refined carbs and sugary treats.
• Avoid high-fat dairy products like butter, cream and cheese.
• Cut out added sugars from sources like candy, desserts and sodas.
• Reduce your intake of red meat.
• Some sufferers have flares after eating seafood.
• Reduce your consumption of caffeine-containing foods and drinks, including coffee, tea, and energy drinks.

Treatment for autoimmune hepatitis typically includes:

• Dietary changes: Eating smaller meals more often throughout the day to avoid putting excess strain on the liver.
• Lifestyle modifications: avoiding exposure to certain chemicals, toxins and other substances that can be hard on the liver.
• Intravenous Immunoglobulin (IVIG): This treatment involves injecting antibodies from donated blood into the patient's bloodstream to help suppress their immune system and reduce inflammation in their liver.
• Liver transplantation: In severe cases, a liver transplant may be necessary if medications fail to improve symptoms or complications occur due to advanced liver damage caused by AIH.

A doctor specializing in liver and gastroenterology care, such as a hepatologist, should be consulted for diagnosis and treatment of autoimmune hepatitis.

• Corticosteroids: This is the first line of treatment for autoimmune hepatitis (AIH). It helps reduce inflammation and suppress the immune system to reduce liver damage.
• Immunosuppressants: These medicines work in combination with corticosteroids to weaken the immune system and help keep it from attacking healthy liver tissue. Examples include azathioprine, mycophenolate mofetil, or cyclophosphamide.
• Antibiotics: Antibiotics can be used to help prevent or treat infections that tend to develop in people with AIH due to a weakened immune system.
• Biological agents: These medications help to block specific pathways in the body that lead to inflammation and can be used to treat autoimmune hepatitis.

The length of time it takes to recover from autoimmune hepatitis can vary depending on the severity of the condition and the response to treatment. Generally, recovery may take anywhere from several weeks to several months.

No, the treatment's effects are not everlasting. Depending on the type of treatment, some may require additional treatments over time to maintain the desired result.

• Monitor for relapse of symptoms: Regularly evaluate liver function tests, such as ALT/AST, albumin, bilirubin, and recheck for hepatitis B and C viruses and other autoimmune markers.
• Monitor for drug side effects: Keep track of any new or worsening signs or symptoms, such as nausea, stomach pain, fatigue and jaundice, that could be related to the treatment medications used to manage auto-immune hepatitis.
• Exercise regularly: Engage in at least 30 minutes of moderate intensity activity daily to maintain physical fitness and help reduce the risk of complications associated with auto-immune hepatitis (such as heart disease).
• Get enough rest: Make sure to get approximately eight hours of sleep each night to help your body heal faster and better cope with any potential flare-ups in symptoms associated with auto-immune hepatitis.

• In general, treatments such as immunosuppressants can range from 500 to 4000 rupees per month, while steroid therapies are generally more expensive, ranging from 3000 to 6000 rupees per month.
• Liver biopsies can cost anywhere from 2500 to 5000 rupees, and tests for diagnosing autoimmune hepatitis can range from 20-100 rupees.
• Finally hospital stays may add additional costs depending upon the length of stay or any special procedures or medications needed.

Common side-effects of Autoimmune Hepatitis treatment include:

• Gastrointestinal disturbances
• Elevated liver enzymes
• Flu-like symptoms
• Anemia
• Hair loss
• Fatigue
• Skin rash.
• Other adverse effects may include worsening liver function, infection due to immunosuppressive therapy and development of deep vein thrombosis or pulmonary embolism in some cases.
• Corticosteroid treatments for severe autoimmune hepatitis can increase the risk for osteoporosis and cataracts requiring monitoring of calcium levels and regular eye exams.
• Long-term immunosuppressive drugs such as azathioprine can cause thinning of the bones, increased risk of infection, nausea or vomiting and skin rashes in some people.

If you are suffering from any complications relating to Autoimmune Hepatitis then you should consult a doctor nearby as they can cause complications like 'scarring of the liver (cirrhosis) and liver failure' in which treatment course can range from a few months to years depending on the severity of the situation.