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Autoimmune Liver Diseases

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What are Autoimmune Liver Diseases?

Autoimmune liver diseases normally occur in Singapore when the body’s immune cells start attacking healthy liver and cells. This may cause inflammation, liver damage, and liver cirrhosis. Autoimmune liver diseases can affect people of all ages, from children to adults. They are life-long diseases and have been known to negatively affect the quality of life due to symptoms, complications, side-effects, and treatments.

There are 3 main types of autoimmune liver diseases, such as:

  • Autoimmune hepatitis: can affect both children and adults.
  • Primary sclerosing cholangitis: biliary ducts are destroyed by the body’s immune cells, thereby affecting the liver’s ability to secrete bile.
  • Primary biliary cirrhosis: inflammation and scarring of the bile ducts, which prevents bile from being secreted.

What are the common causes of Autoimmune Liver Diseases in Singapore?

Autoimmune liver diseases occur when the immune cells start attacking the healthy liver and cells. When this happens, inflammation of the liver will take place which can then lead to liver damage and eventually may even result in liver cirrhosis or liver cancer.

The reason why your body’s immune cells will attack itself is unclear and not fully understood. Autoimmune hepatitis is caused by damage to the liver and its cells, while primary sclerosing cholangitis and primary biliary cirrhosis is caused by damage to the bile ducts.

What are the symptoms of Autoimmune Liver Diseases?

The symptoms of autoimmune liver disease depend on the type of disease:

  • Autoimmune hepatitis: often asymptomatic in the early stages but in some individuals extreme fatigue may occur. In the later stages of autoimmune hepatitis, individuals may present with jaundice or liver cirrhosis. 
  • Primary sclerosing cholangitis: almost half are asymptomatic at diagnosis. Symptoms include jaundice, itchy skin, and pain or discomfort in the upper right side of the abdomen.
  • Primary biliary cirrhosis: often asymptomatic and may only be discovered during liver function tests. 50-60% of individuals with primary sclerosing cholangitis are asymptomatic at diagnosis. Symptoms may develop after a number of years, and they often appear as fatigue and itchy skin (pruritis).

Is Autoimmune Liver Disease painful?

Most of the time, autoimmune liver disease does not cause any symptoms but if symptoms do appear, you may experience some mild discomfort at the upper right side of the abdomen. 

Who is at risk of Autoimmune Liver Disease in Singapore?

The risk factors depend on the type of autoimmune liver disease, such as:

Autoimmune Hepatitis

  • Sex: more common in women.
  • Infections: having a history of certain infections such as, measles, herpes simplex virus, Epstein-Barr virus, hepatitis A, B, and C.
  • Family history: if you have relatives with autoimmune hepatitis, your risk increases.
  • Autoimmune diseases: other autoimmune diseases such as Grave’s disease, coeliac disease, and rheumatoid arthritis may increase your risk of autoimmune hepatitis.

Primary Sclerosing Cholangitis

  • Age: occurs mostly between the ages of 30 to 60.
  • Sex: more common in men.
  • Autoimmune disease: individuals with inflammatory bowel disease (IBD) are likely to develop primary sclerosing cholangitis.
  • Ethnicity: individuals of Northern European descent have a higher risk of primary sclerosing cholangitis.

Primary Biliary Cholangitis

  • Age: occurs mostly between the ages of 30 to 60.
  • Sex: more common in women.
  • Family history: if you have relatives with primary biliary cholangitis, your risk increases.
  • Ethnicity: individuals of Northern European descent have a higher risk of primary biliary cholangitis.

How are Autoimmune Liver Diseases diagnosed?

Different tests are available to diagnose the different autoimmune liver diseases, such as:

Autoimmune Hepatitis

  • Blood tests: blood tests will be able to differentiate between autoimmune hepatitis and viral hepatitis.
  • Liver biopsy: a tissue sample is taken from your liver to check if any liver damage or scarring has occurred. 

Primary Sclerosing Cholangitis

  • Liver function test: this is to test how well your liver is working. You may not show any symptoms, so a liver function test will help identify if your liver is functioning properly. If your liver enzyme levels are high, it may indicate that your liver is injured, stressed, or not functioning properly.
  • Magnetic resonance imaging (MRI): gold-standard for the diagnosis of primary sclerosing cholangitis.
  • Endoscopic retrograde cholangio-pancreatography (ERCP): combination of x-rays and an upper gastrointestinal tract endoscopy to identify or treat problems.
  • Liver biopsy: a tissue sample is taken from your liver to check if any liver damage or scarring has occurred. 

Primary Biliary Cholangitis

  • Liver function test: this is to test how well your liver is working. You may not show any symptoms, so a liver function test will help identify if your liver is functioning properly. If your liver enzyme levels are high, it may indicate that your liver is injured, stressed, or not functioning properly.
  • Antibody tests: done to check for anti-mitochondrial antibodies (AMA), these almost never occur in individuals without the disease, so it is considered to be quite accurate.
  • Cholesterol test: high increase in cholesterol and lipid levels usually signal disease.
  • Ultrasound: used to check for abnormalities within the body.
  • FibroScan®: a special kind of ultrasound that can check for the amount of scarring and fat in the liver
  • Endoscopic retrograde cholangio-pancreatography (ERCP): combination of x-rays and an upper gastrointestinal tract endoscopy to identify or treat problems.
  • Magnetic resonance elastography (MRE): magnetic resonance imaging (MRI) and low-frequency vibrations are combined to produce an elastogram (visual map) of body tissues.

What are the treatment options for Autoimmune Liver Diseases in Singapore?

Treatment options differ between the 3 types of autoimmune liver diseases, these are:

Autoimmune Hepatitis

  • Medication: used to treat symptoms and slow the progress of the disease.
  • Liver transplant: the only way to cure the disease as a healthy liver is transplanted in place of your diseased liver.

Primary Sclerosing Cholangitis

  • Balloon dilation: opens your blocked bile ducts.
  • Stent placement: stent is used to open your blocked bile ducts
  • Liver transplant: the only way to cure the disease as a healthy liver is transplanted in place of your diseased liver.

Primary Biliary Cholangitis

  • Medication: used to treat the symptoms and slow the progress of the disease.
  • Liver transplant: the only way to cure the disease as a healthy liver is transplanted in place of your diseased liver.

Frequently asked questions

Are autoimmune liver diseases curable?
They are only curable if you get a liver transplant, no medication can cure autoimmune liver diseases.
Are autoimmune liver diseases contagious?
No, they are not.

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