Autoimmune Hepatitis

For reasons researchers don’t fully understand, some people’s immune systems attack healthy cells and tissues as if they were foreign invaders. Autoimmune hepatitis is one such condition in which the immune system attacks the liver. Without prompt treatment, the condition and can lead to long-term liver damage, including cirrhosis and liver failure.

Although autoimmune hepatitis is rare in children, it can affect children as young as 2 years old. The condition is more common in girls than boys.

There are two types of autoimmune hepatitis.

• Type 1 is more common than type 2. It can affect people of any age and typically affects more women than men.
• Type 2 typically affects children.

Symptoms of autoimmune hepatitis can vary. Some children have few or no symptoms while others develop symptoms early in the course of the disease.

Symptoms may include:

• Fatigue
• Lost appetite
• Nausea
• Pain in the upper abdomen
• Jaundice
• Dark-colored urine
• Light-colored stools
• Generally feeling unwell for no clear reason

As with other autoimmune diseases, the cause of autoimmune hepatitis is a mystery. Autoimmune diseases are not contagious, and they don't appear to be caused by any one thing in particular. Researchers believe some children to develop autoimmune disease in response to a combination of heredity and environmental factors.

• Heredity: Certain genes passed down by parents make some children more prone to autoimmune hepatitis. However, not all of these children will develop autoimmune hepatitis.
• Environment: Exposure to certain toxins or drugs or some types of infection may trigger autoimmune hepatitis in children with a genetic predisposition.

If your child’s doctor suspects autoimmune hepatitis, they will order a number of tests to confirm the diagnosis.

Tests may include:

• Blood tests to determine if the symptoms are caused by autoimmune hepatitis or another liver condition
• Liver biopsy to look for signs of damage in a small sample of liver tissue
• Imaging tests of your child’s abdomen and liver, such as ultrasound, FibroScan, or magnetic resonance Imaging (MRI)

Like most other autoimmune diseases, autoimmune hepatitis is a chronic condition. However, the condition can be managed and responds well to treatment. Early treatment can reverse liver damage caused by autoimmune hepatitis.

Treatment is aimed at suppressing the exaggerated immune response to prevent continued liver damage. This most frequently involves the use of steroids followed by steroid-sparing medications.

Your child may go into remission after a period of treatment. This is when there are no symptoms or liver damage. If this happens, your child’s doctor may decide to stop the medication but will continue to test your child’s blood to watch for signs of relapse.

Autoimmune hepatitis is a lifelong condition. It is important for your child to see their doctor on a regular schedule to keep the condition under control.

The Center for Childhood Liver Disease at Boston Children’s Hospital specializes in helping infants, children, adolescents, and young adults with a wide variety of liver disorders. Children with liver disease come to us from all over the world because of our extensive experience, dedication, and commitment to finding solutions.

We offer comprehensive care plans focused on your child’s long-term health and wellbeing. Our clinical services include invasive and noninvasive testing and follow up based on your child’s needs. When autoimmune hepatitis is part of a broader disorder involving multiple autoimmune diseases, we collaborate with experts in the Rheumatology Program and Immunology Program to develop the best possible care plan for the child. These, and the many other resources we offer, make Boston Children’s a unique and powerful force in fighting autoimmune hepatitis.