Autoimmune hepatitis (AIH)

It's common to have no symptoms at the early stage. When they occur, symptoms are often non-specific, so your consultant may not immediately attribute them to liver disease. The most common symptoms are:

• fatigue
• joint or muscle pain
• low appetite
• nausea
• itching (pruritus)
• skin rash
• stomach pain or bloating
• diarrhoea
• excessive hair growth (usually in women)
• absent periods or menstruation cycle (amenorrhoea)

More severe symptoms may include:

• build-up of fluid in the legs, feet and ankles (oedema) or the abdomen (ascites)
• confusion (hepatic encephalopathy)
• jaundice
• bruising
• abnormal blood vessels on the skin
• dark urine
• pale, fatty floating stools

Your consultant will discuss your symptoms with you and may recommend tests to aid diagnosis. Diagnosis is made through a combination of an assessment of your medical history, a physical examination, and certain diagnostic tests, which may include:

• Blood tests to quantify immunoglobulins (proteins produced by your immune cells) and autoantibodies (proteins which are markers of this condition).
• Liver function tests (LFT). Blood tests that quantify alanine aminotransferase (ALT) and aspartate aminotransferase (AST), indicators of liver inflammation.
• A liver biopsy may be required, where a tiny piece of your liver is taken to determine the cause of the liver disease.
• Transient elastography which scans for liver fibrosis (scarring) levels.

Once you have been diagnosed with AIH, treatment is almost always needed. The type of treatment used is immunosuppression, which reduces how active your immune system is, in order to control the severity of liver inflammation.

Reducing liver inflammation can improve your symptoms, reduce cirrhosis and help prevent liver failure over the longer term.

Immunosuppression can be achieved by using a combination of medications. Your consultant will discuss your treatment options and help to determine the best approach for you.

Treatment for AIH typically includes the use of corticosteroids, mainly prednisolone, and the immunosuppressant azathioprine.