Autoimmune hepatitis

Overview

Autoimmune hepatitis is a chronic (long-lasting) liver disease. In this condition, the body's immune system, which normally fights infections, mistakenly attacks healthy liver cells. This causes inflammation (swelling) and damage to the liver over time.

No, autoimmune hepatitis is considered a rare disease. It affects about 1 to 2 out of every 100,000 people each year.

It can occur at any age, but it is more common in women (about 70–80% of cases). It can affect children, adults, and older adults.

Symptoms

Common symptoms

• Feeling very tired (fatigue)
• Yellowing of the skin or whites of the eyes (jaundice)
• Pain or discomfort in the upper right part of the belly
• Joint pain
• Itchy skin
• Nausea or loss of appetite

Symptoms in children

• Delayed growth or puberty
• Fever
• Pale or clay-colored stools
• Dark urine

Symptoms in older adults

• Milder symptoms that may be mistaken for normal aging
• Confusion or drowsiness (if the liver is not working well)

Causes

Main causes

• The exact cause is unknown. It is thought to happen when a combination of genetic (inherited) factors and environmental triggers – such as a virus or certain medications – causes the immune system to attack the liver.

Risk factors

• Being female (more common in women)
• Having another autoimmune disease, such as type 1 diabetes, rheumatoid arthritis, or thyroid disease
• A family history of autoimmune conditions

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you notice new or worsening jaundice or severe belly pain, seek same-day medical care.

Book a routine appointment if:

• If you have persistent fatigue, joint pain, or other mild symptoms that concern you, make an appointment with your primary care doctor.

Diagnosis

Diagnosis usually starts with a thorough history, physical exam, and blood tests. Your doctor will check for signs of liver inflammation and rule out other causes of liver damage, such as viruses or alcohol. A liver biopsy (taking a tiny sample of liver tissue) may be needed to confirm the diagnosis and see how much damage has occurred.

Tests that may be done

• Blood tests to measure liver enzymes (ALT, AST), bilirubin, and antibodies (like ANA, anti–smooth muscle antibody)
• Blood tests to check for viral hepatitis (hepatitis B, C) and other causes
• Liver ultrasound or other imaging to look at the liver's structure
• Liver biopsy – a small sample of liver tissue removed with a needle to examine under a microscope

What to expect at your appointment

Your doctor will refer you to a liver specialist (hepatologist or gastroenterologist). The diagnosis may take a few weeks, and you may need several appointments and tests. It's normal to feel anxious, but your healthcare team will guide you through each step.

Treatment

Treatment aims to reduce the immune system's attack on the liver, control inflammation, and prevent scarring. Most people need long‑term medication to keep the disease in remission (quiet and not active).

Self-care at home

• Avoid alcohol completely – it can further damage the liver.
• Eat a balanced, healthy diet with plenty of fruits, vegetables, and whole grains.
• Get enough rest and manage stress – fatigue is common.
• Stay up to date with recommended vaccinations (ask your doctor about vaccines for hepatitis A, hepatitis B, flu, and pneumonia).

Medical treatments

The main treatment is a type of medicine called an immunosuppressant, which lowers the activity of the immune system. In some cases, steroids (corticosteroids) are used for a short period to quickly reduce inflammation. Treatment is tailored to each person, and doses are adjusted over time. Never stop or change your medication without talking to your doctor.

When is surgery considered?

In cases where the liver is severely damaged and not working (liver failure) that does not improve with medication, a liver transplant may be an option. This is major surgery where the damaged liver is replaced with a healthy one from a donor.

Living with this condition

Most people with autoimmune hepatitis need regular blood tests and check‑ups to monitor their liver and adjust treatment. Taking your medication exactly as prescribed is crucial, even if you feel well. It's also important to watch for new symptoms and tell your healthcare team about any changes.

Lifestyle tips

• Avoid alcohol and any medicines that can harm the liver (like large amounts of acetaminophen – check with your doctor or pharmacist).
• Maintain a healthy weight to reduce the strain on your liver.
• Get regular blood tests as recommended by your specialist.
• Limit stress with relaxation techniques like deep breathing, gentle exercise, or hobbies you enjoy.

Diet and exercise

Eat a well‑balanced diet with low salt to help avoid fluid buildup. Stay hydrated and include lean protein, whole grains, and plenty of vegetables. Gentle exercise, such as walking or swimming, can help with energy levels and mood – but listen to your body and rest when you need to.

Mental health and emotional wellbeing

Living with a chronic liver condition can be emotionally challenging. It's normal to feel worried, sad, or frustrated. Talk to your doctor if these feelings are affecting your daily life – they can refer you to a counselor or support group. Remember, you are not alone.

Prevention

There is no known way to prevent autoimmune hepatitis because the exact cause is not clear. However, early diagnosis and proper treatment can prevent or delay liver damage.

Vaccines

Ask your doctor about vaccines that are safe for you, including hepatitis A, hepatitis B, influenza (flu), and pneumococcal vaccines. These can protect your liver from additional infections.

Screening programmes

Routine screening for autoimmune hepatitis in the general population is not recommended. If you have a family history of autoimmune disease or other risk factors, talk to your doctor about any symptoms you may have.

Complications

If left untreated

• Cirrhosis – widespread scarring of the liver that can affect its function
• Liver failure – when the liver can no longer do its job
• Liver cancer (hepatocellular carcinoma)
• Portal hypertension – high blood pressure in the vein that brings blood to the liver

Long-term outlook

With early and consistent treatment, most people with autoimmune hepatitis can achieve remission (no active inflammation) and live a normal lifespan. Some people may need long‑term medication, but many lead full, active lives. The key is regular follow‑up and good communication with your healthcare team.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.