Treatment of autoimmune hepatitis: methods, drugs, side effects, predictions

Many of us have heard of such a disease as autoimmune hepatitis. What is this pathology? This is a chronic disease, which is an unresolved inflammatory phenomenon in an organ as important to our existence as the liver. The established nature of this pathology does not.

What happens in this case?

If the diagnosis is "autoimmune hepatitis," what does this mean? This serious pathology for absolutely unknown reasons gradually destroys the liver cells. Moreover, in this process the immune system of the body helps the disease. At the first stage of the disease there is inflammation of the parenchyma, that is, the main part of the organ. This process is rapidly progressing and can lead to cirrhosis of the liver.

At the same time, cells of such an important organ for us, hepatocytes, die. Their place is immediately filled with coarse and inelastic connective tissue. As a result, the liver is simply not able to perform its functions qualitatively.

You can find different names for this ailment. However, most often in the medical literature pathology is referred to as: active chronic autoimmune hepatitis. This is a rare disease that occurs most often in girls over 10 years of age and in women under the age of thirty.

Symptoms

Clinical manifestations of pathology are different. So, in a quarter of all patients, there are no symptoms of autoimmune hepatitis. And this continues until the person has any complications. In such cases, the disease overtakes people suddenly or they manifest all the symptoms of viral hepatitis or other signs indicating liver damage. At the first variant of development of events of the person the weakness starts to disturb. Its biological fluids acquire a dark color. Skin, and also mucous, turn yellow, appetite disappears. In the second case, extra-hepatic symptoms occur. That is why doctors often assume the presence in the body of various systemic diseases, such as rheumatoid arthritis, lupus erythematosus, etc.

But in general, manifestations of pathology include excessive fatigue, fever, fever up to 39 degrees, increased lymph nodes, acne, abdominal pain, especially in the right upper quadrant, impaired joint function, and active hair growth in all parts of the body . If the disease begins to provoke the synthesis of adrenal hormones that are produced in excess, the patient may have a decrease in muscle tissue on the legs and hands, a quick set of excess weight, the appearance of stretch marks on the hips and a bright blush on the cheeks.

Sometimes in patients, the disease comes suddenly, is acute and proceeds very hard. All this is accompanied by the emergence of fulminant hepatitis, which provokes the rapid death of most of the hepatic cells. This, in turn, leads to the rapid formation of toxins, negatively affecting, and then affecting the brain. It is very difficult, if already appeared autoimmune hepatitis (symptoms), treatment. Forecast in such cases doctors give extremely unfavorable for the patient.

Types of the disease

Treatment of autoimmune hepatitis directly depends on its variety. This or that type of pathology is determined by the presence of a certain kind of antibodies in the blood serum. Three types of autoimmune chronic hepatitis are distinguished:

1. In the first type of disease, proteins-antibodies to actin-protein, smooth muscle cells, antinuclear antibodies are detected.

2. The second type of disease is characterized by the presence of antibodies to microsomes, to kidney and liver cells.

3. The third type of pathology is diagnosed in cases of detection of antibodies to the substance, which is responsible for the synthesis of the protein, that is, to the hepatic soluble antigen.

Causes of pathology

Autoimmune hepatitis is a disease in which human immunity begins an active fight with its own absolutely healthy tissues and cells. What are the causes of this phenomenon? The modern medicine can not answer this question yet. However, scientists have speculation that such a malfunction in the work of the defenses of the body is given by various previously transmitted viral diseases, in particular, hepatitis A, and also B and C, herpes, the Epstein-Barr virus.

Some researchers express the opinion that a certain gene plays the main role in the development of various autoimmune diseases. However, it should be noted that the disease in children under 10 years of age is almost never detected.

Diagnostics

Treatment of autoimmune hepatitis will be much more effective if the disease is detected at an early stage of its development. However, the diagnosis of pathology is extremely difficult. As a rule, doctors put such a diagnosis only with the gradual elimination of the presence of other diseases. To do this, the doctor performs an analysis of the patient's complaints and an anamnesis of his life. All this happens during the conversation. In this case, the specialist finds out what is bothering the person, and how long all this continues.

Next is a physical examination, during which the doctor examines the mucous membranes and skin, measures the patient's body temperature, rattles and probes the liver, finding out its soreness and increase in size. With the existing suspicions of the presence of pathology, laboratory tests are carried out. They are designed to reveal the level of globulin and the activity of the enzyme AST. The direction is also given to the immunological analysis of blood. Examine it for the presence of the hepatitis A virus, as well as B and C. The doctor gives direction to the coprogram. During this study, a stool test is performed for the presence of undigested food particles.

If necessary, instrumental diagnostics is performed. It includes ultrasound, examination of the stomach, esophagus and duodenum with the use of endoscopic equipment. This study is designed to exclude the presence of tumors of various etiologies. The patient is sent to a liver biopsy, during which a small sample of the tissue of this organ is taken for the purpose of its histological examination.

After having diagnosed autoimmune hepatitis diagnosis, and the treatment was prescribed by a doctor, all recommendations received should be strictly followed. Only in this case it is possible to speak about favorable forecasts of the development of the disease.

Ways to eliminate pathology

Once autoimmune hepatitis has been identified (symptoms), and treatment for this ailment has become vital, the doctor can apply several methods. They are as follows:

- in observance of a strict diet;

- in drug therapy;

- in the conduct of surgical intervention.

Let's consider all these methods in more detail.

Diet

Treatment of chronic autoimmune hepatitis, which is in the acute stage, is carried out with strict adherence to bed rest. When the remission phase comes, the patient needs to properly organize his work and rest regime, while avoiding all (emotional and physical) overwork. In addition, it is important to exclude the effect on the liver of various toxic substances, including alcohol and medicines, withdrawn by this body. During the remission period, physiotherapeutic procedures that affect the liver region should not be performed. Balneotherapy is also prohibited.

For the normalization of the patient's condition, proper nutrition is essential. Carrying out treatment of chronic autoimmune hepatitis, gastroenterologists recommend the use of diet (table number 5). It includes vegetable soups and low-fat meat (poultry, beef). In the diet of patients can be included fish in a baked or boiled form. The diet, which is recommended in cases when the treatment of chronic autoimmune hepatitis is required, includes such products as low-fat cottage cheese and cheese, and if there is no intolerance, then dairy as well as dairy products. When preparing dishes for people suffering from autoimmune hepatitis, it is important to consume butter and vegetable oil only in small amounts. The use of eggs should be limited. They can be included in the diet only 2 or 3 times a week for 1-2 eggs per day.

No restrictions are imposed on the diet with regard to vegetables and non-acid fruits. However, their use, like any other permitted food, must necessarily be within reasonable limits.

Diet recommended to a person who is treated with autoimmune hepatitis, excludes from the diet fried foods, fatty meats, salted and hot snacks, sorrel and spinach, cocoa and strong coffee, alcohol and canned food. The food must be necessarily fractional. To eat it is important not less than four times a day, and it is better if food intake will be made six times. It is also important to maintain a balanced diet, so that the body receives all the necessary substances for it.

Application of medicines

If treatment of autoimmune hepatitis is required, the algorithm of the doctor's actions will depend on the stage and course of the pathology. But in any case, in addition to using a diet, the patient is prescribed the necessary medications. Depending on what is observed in a patient with a diagnosis of "autoimmune hepatitis" clinic, treatment by a specialist can be prescribed with the use of various drugs.

Considering the fact that the main cause of this pathology is hyperactivation and a malfunction in the work of the body's defenses, which begin to destroy intensively healthy liver cells, the doctor necessarily includes in the course of therapy medicinal products, whose action is aimed at suppressing immunity. These are immunosuppressive drugs that are hormonal and anti-inflammatory. These include, in the first place, medicines such as Prednisolone and Azathioprine. These two drugs are used in those cases when the treatment of autoimmune hepatitis. In the course of therapy, they can be prescribed individually or together.

As for Prednisolone, this drug has a wide spectrum of action. It has a positive effect on all types of metabolic process, and also allows to obtain a fairly good anti-inflammatory effect. Under the influence of this medication, the activity of the pathological process decreases. And this is due to both direct immunosuppressive action of the agent on K-cells, and its inducing effect on the suppressor function of T-lymphocytes.

Only high doses of this drug are able to provide effective if autoimmune hepatitis (symptoms) is detected, treated. The prognosis of the course of the disease in such cases is quite favorable. Thus, during clinical trials during the course appointment using the medication "Prednisolone", the intensity and frequency of immunopathological reactions observed in liver tissue decreased.

Another drug for the treatment of autoimmune hepatitis is Azathioprine. On the immune response, it affects by the mechanism of suppression of an actively developing clone of immune cells, as well as eliminating the elimination of inflammatory cells.

The drug "Azathioprine" affects both the primary and secondary immune response. However, when treating this medication, many specialists note its insufficient effect. This is due to a violation of the activation of the drug, as well as acceleration of the process of its destruction in cases of liver disease. To eliminate this problem in the course of therapy in parallel assigned another hormone drug - "Prednisolone." It is able to activate the action of "Azathioprine". In addition, side effects after the treatment of autoimmune hepatitis with the combined use of two drugs are four times less than those observed with the use of only one Prednisolone. This clearly indicates the need for this approach to treatment.

The use of two drugs simultaneously depresses the development of the inflammatory process and enables the defenses of the body to eliminate the existing failures independently. Unfortunately, patients are forced to take these medicines from six months to four years. At the same time, doctors do not give any guarantees that this course will be the only one. Many patients have to repeat it more than once during their lifetime.

A similar algorithm of therapy is also used in cases where autoimmune hepatitis is treated in children.

To eliminate the pathology, coenzymatic and metabolic drugs can be used. They are such vitamin and multivitamin complexes as "Cocarboxylase", "Riboxin" and many others. In complex therapy, hepatoprotectors are found that contain phospholipids. These are such drugs as "Livolin", "Essentiale", "Heptral" and many others. According to experts, the appointment of such funds should be made only in the stage of remission, when there is no pronounced inflammatory process.

In order to remove from the body those toxic metabolic products that the liver can not cope with, doctors prescribe intravenous infusion therapy. As a rule, in such cases, the drug "Rheosorbylact" or saline is used. The procedure is performed under the constant control of blood pressure and urine output.

Alternative therapy regimen

Treatment using a combination of drugs such as Prednisolone and Azathioprine has been effectively used in medical practice for almost five decades. This therapy has significantly increased the life expectancy of patients with autoimmune hepatitis.

However, discussions about the use of other schemes, which would become less prolonged for patients and cause fewer side effects, are now growing in intensity. For example, experts are considering the possibility that the treatment of autoimmune hepatitis "Budenofalk" can be carried out. This drug belongs to the group of glucocorticosteroids of the second generation. In addition, it has a minimum of side effects and is ninety percent metabolized by the liver already on its first passage through it. This also contributes to the restoration of health in patients suffering from autoimmune hepatitis.

The results of the conducted clinical trials convincingly proved the fact that the preparation "Budenofalk", when used in combination with "Azathioprine", induced and supported remission in those people with autoimmune hepatitis who had not yet shown signs of cirrhosis. At the same time, therapy resulted in the appearance of side effects less than after the application of Prednisolone.

According to researchers, this drug is able to become a new standard of clinical therapy, used to get rid of autoimmune hepatitis.

Surgery

In those cases where the use of drug therapy for four years does not improve the patient's condition and does not normalize his biochemical blood index, the patient is promptly intervened.

It is an operation for the transplantation of a donor organ. As a rule, for this purpose, part of the liver of the human blood is taken.

Folk remedies

The use of funds, the recipe of which was created by healers on the basis of natural components, allows evacuating bile, eliminating nausea and intoxication phenomena, as well as relieving pain syndrome.

It should be borne in mind that if an autoimmune hepatitis is detected in a person, treatment with folk remedies will only alleviate the symptoms of the disease, but it will not completely get rid of it. Such methods are effective enough only for those pathologies that are easy to treat. This applies to hepatitis A or to its toxic type.

Well proven in the fight against inflammatory phenomena in the liver are various herbs that have choleretic effect. From them prepare infusions and broths. Such medicinal herbs include:

- roots and leaves of nettle;
- mint and anise;
- Yarrow;
- seeds of fennel;
- St. John's wort;
- Birch leaves.

From the medicinal herbs are made the fees that are taken before eating. Prepared infusions of rose hips replace tea. Drink it through a straw, since this agent has a negative effect on the enamel of the teeth.

Positively affects the liver and juice of various vegetables, because it contains a large number of vitamins and useful elements. To treat hepatitis at home, juice can be used:

- Jerusalem artichoke;
- raw potatoes;
- Carrots, diluted with water;
- celery and dandelion leaves;
- raw beets, diluted with water.

Forecast

Survival of patients suffering from autoimmune hepatitis, completely depends on the intensity of the inflammatory process passing through the liver. In mild cases, in 80% of people it is more than 15 years. However, in the absence of full-fledged therapy and in the severe course of the disease, only units manage to live more than five years.