Tests and procedures used to diagnose autoimmune hepatitis include:
- Blood tests. Testing a sample of your blood for antibodies can distinguish autoimmune hepatitis from viral hepatitis and other disorders with similar symptoms. Antibody tests also help pinpoint the type of autoimmune hepatitis you have.
- Liver biopsy. Doctors perform a liver biopsy to confirm the diagnosis and to determine the degree and type of liver damage. During the procedure, a small amount of liver tissue is removed, using a thin needle that's passed into your liver through your skin. The sample is then sent to a laboratory for analysis. Your doctor may use ultrasound to guide the biopsy.
Whatever type of autoimmune hepatitis you have, the goal of treatment is to slow or stop the immune system attack on your liver. This may help slow the progression of the disease. To meet this goal, you’ll need medications that lower immune-system activity. Treatment with prednisone is generally used initially. A second medication, azathioprine (Azasan, Imuran), may be recommended in addition to prednisone.
Prednisone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, thinning bones (osteoporosis), broken bones (osteonecrosis), high blood pressure, cataracts, glaucoma and weight gain.
Doctors typically prescribe prednisone at a high dose for about the first month of treatment. Then, to reduce the risk of side effects, they gradually reduce the dose over the next several months until reaching the lowest possible dose that controls the disease. Adding azathioprine also helps you avoid prednisone side effects.
Most people need to continue taking the prednisone for at least 18 to 24 months, and many remain on it for life. Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued.
When medications don't halt the progress of the disease, or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.
During a liver transplant, your diseased liver is removed and replaced by a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a portion of a healthy liver from a living donor. Both livers begin regenerating new cells almost immediately.
Preparing for your appointment
If you have any signs or symptoms that worry you, start by making an appointment with your primary care doctor. If your doctor suspects you may have autoimmune hepatitis, you may be referred to a specialist in liver diseases (hepatologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along to help you remember everything that was discussed.
- Write down questions to ask your doctor.
For autoimmune hepatitis, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there any other possible causes?
- What tests do I need to confirm that I have autoimmune hepatitis?
- How severe is the damage to my liver?
- Is my condition likely temporary or chronic?
- What are my treatment options?
- Can treatment cure my autoimmune hepatitis?
- What are the potential side effects of each treatment option?
- How might treatment for autoimmune hepatitis affect the management of my other medical conditions?
- Could any of my medications or habits cause my liver problems or make my liver problems worse?
- Are there any dietary restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- How often will I need follow-up visits?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- How severe are your symptoms?
- Does anything seem to improve or worsen your symptoms?
- Are you taking any medicines or treatments for your symptoms?
- Do you have a family history of liver disease?