World Hepatitis Day 2023: What is autoimmune hepatitis?
World Hepatitis Day is observed on July 28 each year to raise awareness about hepatitis, a condition characterized by inflammation of the liver. According to the American National Institute of Health, the prevalence of autoimmune hepatitis varies, affecting four to 43 out of 100,000 adults and about 2 to 10 out of 100,000 children.
Dr. Naveen Polavarapu, a senior consultant gastroenterologist, liver specialist, and advanced therapeutic endoscopist & endosonologist at Hyderabad’s Yashoda Hospitals, provided insights into hepatitis. He explained that hepatitis is a broad term referring to liver inflammation, a crucial organ in the body responsible for various vital functions.
There are several forms of hepatitis, each with distinct causes and modes of transmission. Autoimmune hepatitis is one such form where the body’s own immune system mistakenly attacks liver cells, resulting in liver inflammation. This condition can lead to liver damage and, if left untreated, may progress to severe liver diseases.
World Hepatitis Day serves as an opportunity to educate the public about different types of hepatitis, their risk factors, prevention measures, and the importance of early detection and proper management. By raising awareness and encouraging people to take preventive measures and seek medical advice, the hope is to reduce the burden of hepatitis on individuals and communities worldwide.
Dr. Akash Shukla, the director of hepatology at Mumbai’s Sir HN Reliance Hospital, provides important insights into the potential complications of autoimmune hepatitis. This condition, where the body’s immune system attacks liver cells, can lead to various severe outcomes:
- Acute Liver Failure: In some cases, autoimmune hepatitis can cause a sudden and rapid loss of liver function, leading to acute liver failure. This is a critical condition that requires immediate medical attention, as it can be life-threatening.
- Acute Chronic Liver Failure: Autoimmune hepatitis can also result in a state of acute-on-chronic liver failure, where a patient with pre-existing liver disease experiences an acute deterioration in liver function. This can be a very serious and challenging situation to manage medically.
- Chronic Hepatitis Cirrhosis: If autoimmune hepatitis is left untreated or poorly managed, it can progress to chronic hepatitis cirrhosis. Cirrhosis is a condition where healthy liver tissue is replaced by scar tissue, leading to loss of liver function and potential complications.
Managing autoimmune hepatitis requires a comprehensive approach that may include immunosuppressive medications to control the immune response and reduce liver inflammation. Regular monitoring and follow-up with a healthcare provider are essential to track the condition’s progress and adjust the treatment plan accordingly.
World Hepatitis Day serves as a reminder to raise awareness about different forms of hepatitis, including autoimmune hepatitis, and to emphasize the importance of early diagnosis, appropriate medical care, and lifestyle measures to protect liver health.Dr. Naveen Polavarapu highlights that autoimmune hepatitis can manifest at any age and affect individuals of any race or sex. However, it is more prevalent in females, with the condition being approximately four times more common in women than in men.
The exact reasons why autoimmune hepatitis develops are not fully understood. Researchers believe that genetic factors might play a role, with some individuals potentially inheriting a genetic predisposition that makes them more susceptible to the condition. Additionally, certain drugs or infections could trigger the onset of autoimmune hepatitis in some cases.
Dr. Akash Shukla explains that individuals with one autoimmune disorder might be at an increased risk of developing another autoimmune disorder. For example, if someone already has conditions such as vitiligo (characterized by white spots on the body), hypothyroidism, type 1 diabetes, systemic lupus erythematosus (SLE), or celiac disease, they could be at a higher risk of developing autoimmune hepatitis.
The correlation between autoimmune disorders underscores the complexity of the immune system and its potential to misidentify healthy tissues as threats, leading to autoimmune reactions. Early diagnosis, regular monitoring, and effective management are essential for individuals with autoimmune hepatitis or any other autoimmune condition to ensure optimal health outcomes and prevent further complications.
Dr. Akash Shukla suggests another hypothesis, the hygiene hypothesis, to explain the development of autoimmune and allergic disorders. According to this hypothesis, individuals who have been raised in excessively clean and sterile environments may be at a higher risk of developing such conditions.
The hygiene hypothesis proposes that reduced exposure to certain microorganisms during early childhood might negatively impact the development of the immune system. The lack of exposure to various pathogens and microbes could lead to an imbalanced immune response, where the immune system becomes overly sensitive and more prone to attacking the body’s tissues, resulting in autoimmune disorders.
This hypothesis is based on the idea that some level of exposure to certain microbes is necessary for the immune system to mature and differentiate between harmless substances and harmful invaders. Without this exposure, the immune system might be more likely to mistakenly attack the body’s own cells and tissues, leading to autoimmune diseases.
The hygiene hypothesis has been linked not only to autoimmune disorders but also to an increased risk of developing allergies and other immune-related conditions. It emphasizes the importance of a balanced and appropriately trained immune system, which can be achieved through exposure to diverse microbial environments during early life.
It’s important to note that the hygiene hypothesis is just one of several theories attempting to explain the rise in autoimmune and allergic disorders. The exact causes of these conditions are likely multifactorial and involve a combination of genetic, environmental, and immunological factors.
Further research is needed to understand the mechanisms underlying the development of autoimmune disorders fully and to identify effective preventive and therapeutic approaches.While it may not be possible to prevent autoimmune disorders, including autoimmune hepatitis completely, there are specific measures that can potentially reduce the risk or delay the onset of these conditions.
- Balanced Environment: As mentioned in the hygiene hypothesis, allowing a child to grow up in a more diverse and balanced environment with regular exposure to various microbes and antigens might help properly develop and regulate the immune system.
- Healthy Lifestyle: Maintaining a healthy lifestyle, including a well-balanced diet, regular exercise, and adequate sleep, can contribute to overall well-being and potentially support the immune system.
- Minimize Stress: Chronic stress has been linked to immune system dysregulation, so managing stress through relaxation techniques, hobbies, or meditation may be beneficial.
- Avoid Harmful Substances: Avoiding excessive alcohol consumption and harmful substances can help maintain liver health and reduce the risk of liver-related disorders.
- Regular Check-ups: Regular medical check-ups can aid in early detection of autoimmune hepatitis or any other health issues, enabling timely intervention and appropriate management.
As for the symptoms of autoimmune hepatitis, Dr. Naveen Polavarapu explains that many individuals with this condition may not initially experience noticeable symptoms. In some cases, the disorder may be detected incidentally through routine laboratory tests done for other reasons. However, when symptoms do occur, they can include:
- Fatigue
- Jaundice (yellowing of the skin and eyes)
- Abdominal pain or discomfort
- Joint pain or swelling
- Loss of appetite
- Nausea or vomiting
- Dark-colored urine
- Pale-colored stools
It’s important to note that symptoms can vary from person to person, and some individuals may experience more severe manifestations of the disease. If someone suspects they might have autoimmune hepatitis or experiences any concerning symptoms, seeking medical attention for proper evaluation and diagnosis is essential. Early detection and appropriate treatment can significantly improve outcomes and prevent complications.
Dr. Naveen Polavarapu highlights that when symptoms are present in autoimmune hepatitis, fatigue is the most common complaint. However, there can be additional symptoms such as jaundice (yellowing of the skin or eyes), itching, skin rashes, joint pain, abdominal discomfort, nausea, vomiting, loss of appetite, dark urine, and pale or grey-colored stools. In its advanced stages, autoimmune hepatitis can lead to cirrhosis, a severe scarring of the liver.
Early diagnosis is indeed crucial in managing autoimmune hepatitis effectively. Dr. Akash Shukla emphasizes the importance of regular check-ups and early detection through appropriate blood tests and sonography fibro scans. Timely diagnosis enables prompt initiation of treatment, which can prevent disease progression, reduce liver damage, and improve the overall prognosis.
Routine medical check-ups and tests can help identify any abnormalities in liver function or detect autoimmune hepatitis in its early stages, even before symptoms become evident. This proactive approach allows healthcare providers to implement appropriate treatment strategies promptly and potentially prevent complications associated with advanced liver disease.
People who have a family history of autoimmune disorders or other risk factors should be vigilant about their health and seek medical attention if they experience any concerning symptoms.
Early intervention and proper management can significantly enhance the quality of life for individuals with autoimmune hepatitis and help them maintain better liver health in the long term.Dr. Akash Shukla explains that autoimmune hepatitis can show varying patterns of remission.
Around 10 to 40 percent of individuals with the condition may experience a remission phase where they no longer require medications to manage their disease. However, it is essential to note that remission does not necessarily mean the complete cure of autoimmune hepatitis.
Of those who enter remission, only about 20 to 30 percent are likely to remain in a sustained remission state, meaning they can continue without medications and maintain stable liver function. The majority of people may experience relapses or fluctuations in their disease activity, requiring either continuous therapy or additional rounds of medication to manage the ongoing disease.
Since autoimmune hepatitis is a chronic condition, managing the disease often involves long-term treatment and regular monitoring to ensure optimal liver function and prevent disease exacerbations. Treatment strategies may include immunosuppressive medications, corticosteroids, and other therapies to suppress the autoimmune response and reduce liver inflammation.
Individual responses to treatment can vary, and medical management should be tailored to each person’s specific needs and disease progression. Consistent medical follow-ups, regular liver function tests, and ongoing communication with healthcare providers are crucial to ensure appropriate adjustments in treatment and maintain the best possible outcomes for individuals with autoimmune hepatitis.
