Autoimmune hepatitis in children
Autoimmune hepatitis is a disease in which the body's immune system attacks liver cells.
The immune system protects the body from viruses, bacteria, and other living organisms. It usually does not react against the body's own cells. However, sometimes the immune system gets confused and attacks the cells it is supposed to protect. This is what happens in autoimmune hepatitis. The immune system attacks liver cells, causing inflammation (hepatitis).
There are two types of autoimmune hepatitis
Type 1 is the most common form in North America. It usually starts in adolescence.
Type 2 autoimmune hepatitis is less common. It usually affects girls aged two to 14.
Signs and symptoms of autoimmune hepatitis
Fatigue is the most common symptom of autoimmune hepatitis.
Symptoms of autoimmune hepatitis range from mild to severe and may include:
- jaundice
- itching
- skin rashes
- joint pain
- abdominal discomfort
- nausea
- vomiting
- loss of appetite
- dark urine
- pale or grey-coloured stools
Certain medicines and viruses can also cause hepatitis. The symptoms of these diseases are similar to autoimmune hepatitis. Your child's health-care provider will run tests for an accurate diagnosis. They should review all medicines including herbs and supplements your child may be taking.
What causes autoimmune hepatitis?
A person's genes may make them more prone to autoimmune diseases. As a result, they may be more likely to develop autoimmune hepatitis. Environmental factors such as certain bacteria, viruses, toxin and drugs may trigger autoimmune hepatitis.
About 70 per cent of those with autoimmune hepatitis are female.
Diagnosing autoimmune hepatitis
In addition to looking at your child's clinical history and symptoms, your child's health-care provider will run blood tests and do a liver biopsy to confirm the diagnosis.
Blood tests for autoimmune hepatitis
When the liver is damaged, it releases enzymes into the blood. Taking routine blood tests for liver enzymes measures the degree of inflammation and irritation of the liver.
However, to clearly diagnose autoimmune hepatitis, the health-care provider tests for specific proteins called autoantibodies. These proteins attack the body's cells.
In autoimmune hepatitis, the immune system makes one or more types of autoantibodies.
- Antinuclear antibodies (ANA).
- Anti-smooth muscle antibodies (SMA).
- Anti-liver kidney microsomal antibodies (anti-LKM).
Children with type 1 autoimmune hepatitis have higher levels each of ANA, SMA, or both.
Children with type 2 autoimmune hepatitis have increased amounts of anti-LKM.
Liver biopsy for autoimmune hepatitis
By obtaining a tiny sample of the liver tissue through a liver biopsy, doctors are able to diagnose autoimmune hepatitis. They do this by examining the tissue under a microscope. This procedure is done in the hospital and most children go home the same day (see instructions on how to care for your child at home after the procedure).
Treatment for autoimmune hepatitis
There is not yet a medical cure for this condition. However, medicines can effectively control autoimmune hepatitis. They work by suppressing, or slowing down, an overactive immune system. Studies show that taking these medicines properly stops the disease from getting worse. t may also reverse some of the scarring in the liver, which can develop as a result of inflammation.
Both types of autoimmune hepatitis are treated with daily doses of the following medicines: prednisone and/or azathioprine.
Treating autoimmune hepatitis with prednisone
Prednisone helps suppress the immune system and reduces inflammation in the liver. The health-care teammay start treatment using a high dose of prednisone. The health-care team monitors your child's blood one to two times a week. As the liver enzymes decrease and the disease becomes under control, the health-care team will reduce the amount of prednisone given to your child.
Treating autoimmune hepatitis with azathioprine
Azathioprine also suppresses the immune system. It is often added once the disease is under control. Your child takes azathioprine in addition to prednisone. Taking azathioprine allows prednisone to be given at a lower dose. This helps reduce prednisone's side effects.
Liver transplant may be an option for some children
In the majority of cases, prednisone and other anti-inflammatory medicines can control the inflammation. However, sometimes, inflammation persists anyway, or it was not detected early enough. In both cases, the inflammation causes scarring inside the liver. The increased scar tissue is called cirrhosis. As cirrhosis worsens, it eventually causes the liver to stop working properly. In these cases, some children may undergo a liver transplant. If this is an option for your child, their health-care provider will talk to you about the procedure and implications.
Communicate with your child's health care team
Talk openly with your child's health-care provider if you have any questions or concerns about your child's treatment. Make sure you update them with any new symptoms your child may experience. Remember the health-care team is there to support you and your child.