Autoimmune hepatitis

Autoimmune hepatitis is a chronic inflammatory disease of hepatic tissue of unknown aetiology characterized by serological reactivity of various types of autoantibodies and hypergammaglobulinaemia. It predominantly affects younger or middle-aged women. If untreated, in the majority of cases there occurs gradual disease progression and development of liver cirrhosis with all its consequences. Clinical manifestations are not uniform, with several manifestation phenotypes having been identified: acute hepatocellular injury resembling acute viral hepatitis; more rarely, a manifestation in the form of fulminant hepatitis; most commonly, however, the disease has a silent clinical course, with a chronic mild elevation in serum hepatic transaminase activity being the only possible sign of liver disease. In clinically less obvious cases, recognition of the disease may be a diagnostic challenge. In these cases, several scoring systems can be used that effectively aid in diagnosing the condition. The therapeutic goal is to achieve a complete response defined as full normalization of the serum ALT and AST activities, as well as normalization of serum gamma globulin concentration. The treatment is divided into two phases: induction and maintenance. The administration of prednisone in monotherapy or in combination with azathioprine is the basic procedure in both phases. Relapses are very frequent when treatment is discontinued, with as many as 80% of the patients having a relapse within three years.

Keywords: autoimmune hepatitis, immunosuppressive therapy, liver cirrhosis.