Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Treating Autoimmune Hepatitis

Friday, 08 April 2011 02:45 PM

Question: I have autoimmune hepatitis. Is there anything I can do to help my liver, other than eliminate alcohol?

Dr. Hibberd’s Answer:

Autoimmune hepatitis is a genetically inherited condition in which the body’s immune system mistakes the liver cell architecture as foreign and stages a full-blown immune attack on the liver. If the attack is unchecked, scarring (cirrhosis), loss of liver function, and liver failure result.

Autoimmune hepatitis, which often is associated with other autoimmune diseases, is not a preventable disorder. Close monitoring is very important, particularly with mild cases that may be left untreated or when the condition is in remission.

Avoiding stress and other illnesses, which can activate the immune system, is important, as is getting enough sleep and regular exercise. Eating a low-fat diet will reduce the chance of fatty liver, which can further complicate liver function. B vitamin and CoQ10 supplementation with a diet high in green vegetables will help maintain good liver function.

As you know, staying away from alcohol is important, but using some over-the-counter medicines is OK. For pain relief, use no more Tylenol than necessary and keep daily dosing intermittent and less than 1,800 mg. Taking low doses intermittently of ibuprofen also is appropriate with daily maximum dosing kept to less than 1,200 mg.

Do not self-medicate or use immune or liver stimulants advertised on the Internet. Some can interfere with the chemotherapy agents used to treat autoimmune hepatitis.

The objective of treatment for autoimmune hepatitis is to induce remission to prevent cirrhosis and liver failure. Most initial treatment protocols involve titrated imuran and prednisone combined; more resistant cases are treated with stronger immune suppressants such as cyclosporin or tacrolimus.

Eighty percent of cases achieve remission with treatment within three years; 65 percent of cases do so within 18 months of therapy initiation. Recurrences do occur and are most often seen 15 months or more after remission therapy has been interrupted. Some cases remain in remission for years.

With treatment, 10- and 20-year survival rates exceed 80 percent. Liver transplantation is available to some who don’t achieve remission induction with medication or who develop end-stage cirrhosis and liver failure.

Consult an aggressive gastroenterologist familiar with this condition who will work with your hematologist/immunologist to obtain optimal remission and control. New developments are on the horizon that may offer more focused remission induction including blocking peptides, T-cell vaccination, cytokine therapy, gene therapy, and stem-cell therapy options.

© HealthDay

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