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    Your body's immunity can damage your liver: Watch out for these signs

    Synopsis

    Autoimmune liver disease can be transmitted genetically or is caused because of some reactions wherein the liver cells are recognised as infectious.

    By Dr Mohamed Rela

    Liver disease occurs due to a variety of reasons. Alcohol consumption, viral infections such as hepatitis B or hepatitis C and fatty liver are the common causes of chronic liver disease. All these are external factors leading to liver injury.

    Autoimmune liver disease is a unique condition where our own immunity, which is supposed to fight foreign antigens such as viruses or bacteria, starts damaging the liver. This can be transmitted genetically or because of some reactions wherein the liver cells are recognised as infectious or foreign agents called molecular mimicry. Autoimmune liver disease comprises autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and rarely, immunoglobulin 4 (IgG4)-associated sclerosing cholangitis.

    These conditions were once considered to be rare in our population, but this is no longer true. In a study from India, out of 1,760 patients of cirrhosis, autoimmune liver disease was found in 45% of women and 10% of men, indicative of under-recognition of this serious liver disease.

    Autoimmune hepatitis (AIH) is the disease of the liver cells (hepatocytes), commonly seen in middle-aged women and characterised by the presence of autoantibodies such as ANA or SMA, raised immunoglobulin G levels in the blood and good response to steroids in the absence of viral or drug history. The condition is also recognised in children.

    Liver biopsy is the gold standard to confirm the diagnosis. Patients can be completely asymptomatic with deranged liver tests to symptomatic in the form of fatigue, body ache or joint pains.

    Presence of jaundice may indicate coexisting overlap syndrome (either with PBC or PSC) or end-stage liver disease. Patients with end-stage liver disease will have fluid accumulation in the belly, may vomit blood, become weak and sometimes be confused and disoriented.

    If identified early, AIH is one of the few conditions amenable to treatment, before progression to end-stage liver disease.

    Characteristically, there is an excellent response to medications that suppress the body’s immune system such as prednisone (steroids) and azathioprine. These are long-term therapies and therefore patients should be monitored closely for treatment response and drug side-effects. It is important to note that not uncommonly, AIH can present as acute liver failure where an urgent liver transplantation will save the patient’s life. Going for other systems of medicine and use of alcohol are strictly prohibited.

    When immune cells damage bile duct cells of the liver, it can result in primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC). PBC is predominantly seen in middle-aged to elderly females. They commonly present with profound tiredness (fatigue) and itching. They may have other associated autoimmune conditions such as hypothyroidism.

    PBC is diagnosed by the presence of anti-mitochondrial antibodies 95% of the time. Jaundice is a late feature and a sign of progression to end-stage liver disease. Liver biopsy will show destruction of bile ducts leading to inflammation and bile duct loss.

    PSC also occurs due to destruction of bile duct cells. However, it leads to narrowing stricture formation of larger bile ducts, leading to recurrent bile duct infections. Consequently, these patients present with repeated attacks of jaundice and fever, requiring hospitalisation and antibiotics. Unlike AIH or PBC, men are more commonly affected.

    Importantly, these patients are at risk of the dreadful primary bile duct cancer (cholangiocarcinoma). Medical treatment at present is limited. Liver transplantation is the best curative option when there is progressively worsening liver function.

    If your liver tests are abnormal, kindly consult an expert for early identification and treatment.


    —The writer is Director, Institute of Liver Disease and Transplantation, Gleneagles Global Hospitals.

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