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Autoimmune hepatitis
Last reviewed: 07.07.2025
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Autoimmune hepatitis is a chronic hepatitis of unknown etiology, in the pathogenesis of which autoimmune mechanisms play a leading role.
The disease is more common in women (the ratio of men to women in autoimmune hepatitis is 1:3), the most frequently affected age is 10-30 years.
Etiology
The etiology is unknown. Immune changes are evident. Serum gamma globulin levels are extremely high. Positive LE cell test results in approximately 15% of patients have led to the term "lupoid hepatitis". Tissue antibodies are found in a significant proportion of patients.
Chronic (lupoid) hepatitis and classical systemic lupus erythematosus are not identical diseases, since classical lupus rarely shows any changes in the liver. Moreover, patients with systemic lupus erythematosus do not have antibodies to smooth muscles and mitochondria in their blood.
In the pathogenesis of autoimmune hepatitis, an important role belongs to defects in immune regulation, in particular, a decrease in the T-suppressor function of lymphocytes and the appearance of various autoantibodies. These antibodies are fixed on the membrane of hepatocytes, due to which conditions are created for the development of antibody-dependent cytotoxic reactions that damage the liver and cause the development of immune inflammation.
Causes and pathogenesis of autoimmune hepatitis
Clinical picture
The disease occurs predominantly in young people; half of the patients are between 10 and 20 years old. The second peak of the disease is observed during menopause. Three quarters are women.
In most cases, the pattern of liver disease is inconsistent with the established duration of symptoms. Chronic hepatitis may remain asymptomatic for months (and possibly years) before jaundice becomes apparent and the diagnosis can be made. The disease may be recognized earlier if routine testing reveals stigmata of liver disease or if liver function tests are abnormal.
Symptoms of autoimmune hepatitis
Laboratory data
- Complete blood count: normocytic, normochromic anemia, mild leukopenia, thrombocytopenia, increased ESR. Due to severe autoimmune hemolysis, a high degree of anemia is possible.
- General urine analysis: proteinuria and microhematuria may appear (with the development of glomerulonephritis); with the development of jaundice, bilirubin appears in the urine.
Diagnosis of autoimmune hepatitis
Treatment
Controlled clinical trials have shown that corticosteroid therapy prolongs survival in severe chronic hepatitis type I.
The benefits of treatment are especially evident in the first two years. Weakness decreases, appetite improves, fever and arthralgia are treatable. The menstrual cycle is restored. Bilirubin, γ-globulin and transaminase levels usually decrease. The changes are so pronounced that they can be used to establish a diagnosis of autoimmune chronic hepatitis. Histological examination of the liver during treatment reveals a decrease in the activity of the inflammatory process. However, it is not possible to prevent the outcome of chronic hepatitis into cirrhosis.
Treatment of autoimmune hepatitis
The course and prognosis of autoimmune hepatitis are extremely variable. The course is undulating with episodes of deterioration, when jaundice and weakness increase. The outcome of chronic hepatitis proceeding in this way, with rare exceptions, is inevitably cirrhosis.
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