Autoimmune hepatitis in children

Autoimmune hepatitis occurs when your immune system—the body's main defense against germs—attacks liver cells. Your doctor may also call this chronic autoimmune hepatitis. This is a liver disease that you must control for the rest of your life.

There is no cure for autoimmune hepatitis, but treatment can help manage symptoms and prevent liver damage.

Symptoms of autoimmune hepatitis

You may not notice any symptoms. If you do, they can range from mild to severe.

Symptoms such as fever, abdominal pain, and yellowing of the skin and eyes may appear suddenly. Most often, symptoms appear within a few weeks or months.

The most common symptom is feeling tired. You may also have:

Joint or muscle pain
Lack of appetite and weight loss
Nausea, vomiting, or belly pain
Acne and skin rashes
Pee that is dark or very yellow
Bowel movements that are light-colored
Diarrhea
Lack of menstrual period
Jaundice (yellowing of your skin or eyes)
Enlarged spleen
Gallstones
Brain problems (hepatic encephalopathy)

Types of autoimmune hepatitis

There are two main types of autoimmune hepatitis. Both are rare.

Type 1 is the most common type. You are most likely to get it if you are a woman between the ages of 15 and 40, although people of any age and gender can get it.
Type 2 usually occurs in girls between the ages of 2 and 14.

If you have autoimmune hepatitis, you probably also have another autoimmune disease, such as ulcerative colitis, rheumatoid arthritis, lupus, or Sjögren's syndrome.

Causes and risk factors for autoimmune hepatitis

Doctors don't know exactly what makes your immune system turn against your liver. Your genes may have something to do with it, since autoimmune hepatitis can be inherited.

But genes are not everything. Something you come into contact with can trigger autoimmune hepatitis in your genes. This may include:

Medications such as statins and hydralazine (used to treat the heart) or antibiotics such as nitrofurantoin and minocycline
Stress
Infections such as viral hepatitis, herpes, Epstein-Barr and measles

Diagnosis of autoimmune hepatitis

Your doctor will ask you about your symptoms. They will also want to know what medications you are taking and how much alcohol you are drinking. Both can damage your liver.

They will order blood tests that can rule out other conditions, such as viral hepatitis. Blood tests can also detect so-called autoantibodies, which can be signs of an autoimmune disease. Other blood tests can show if your liver is damaged.

Your doctor will do a liver biopsy. They will take a small piece of your liver and examine the cells under a microscope.

Complications of autoimmune hepatitis

Sometimes, autoimmune hepatitis can cause damage to the liver called cirrhosis. This can cause problems, including:

Itching
Bruising
Bleeding that won't stop
Swollen stomach or ankles
Spidery blood vessels
Confusion

Treatment of autoimmune hepatitis

If you do not have symptoms of autoimmune hepatitis, your doctor may decide not to treat you right away. Instead, you will have occasional blood tests and a liver biopsy to make sure your liver is healthy.

Treatment usually starts when you have symptoms or your doctor notices worsening lab results. First, they will likely prescribe prednisolone, a steroid that reduces inflammation. They may start with a high dose, then lower it and add azathioprine or 6-mercaptopurine, which can weaken your immune system.

These drugs may have side effects. Steroids can weaken bones, lead to weight gain, and cause vision problems. Azathioprine and 6-mercaptopurine can lower your white blood cell count and increase your chance of developing cancer.

Doctors sometimes use the steroid budesonide instead of prednisolone. Your doctor may suggest other drugs that suppress your immune system instead of azathioprine, such as mycophenolate mofetil.

After 3 years of treatment, about 80% of people find that their condition is under control. You may stop treatment while your doctor monitors your health. If your symptoms return, you will resume treatment.

Lifestyle changes can help you stay healthy. Eat a balanced diet, eat plenty of fruits and vegetables, and avoid alcohol. Do not take any medications or supplements without consulting your doctor.

If you have cirrhosis or liver failure, you may need a liver transplant. This is an operation to remove the damaged liver and replace it with a healthy liver from a donor.