In most cases, autoimmune liver diseases take a slow course over many years or even decades. A long life and a good quality of life despite the chronic disease is possible for most affected patients due to the availability of effective therapies. The main condition for successful treatment is the correct diagnosis. Once the diagnosis is made, the treatment strategy can be chosen and adapted to the individual patient. There are different therapies for the different types of autoimmune liver disease.
… have a suppressive influence on the immune system. They also suppress the autoimmune activity. They are very effective against autoimmune hepatitis (AIH). Two of the most important immunosuppressants are corticosteroids (“cortisone”) and azathioprine (AZT). Patients with an autoimmune hepatitis undergoing immunosuppressive treatment have a normal life expectancy with a good quality of life. In other autoimmune liver diseases –primary biliary cirrhosis (PBC) and the primary sclerosing cholangitis (PSC) the effectiveness of immunosuppressants is not clearly proven.
… is a bile acid that is very effective in primary biliary cirrhosis. It protects the bile duct cells from the autoimmune reaction by mechanisms not well understood. Especially in early stages when the disease has not progressed to marked liver damage it can be treated well with UDCA. UDCA is also used in primary sclerosing cholangitis, but its effectiveness in this condition is controversial.
All autoimmune liver diseases may damage this essential metabolic organ to an extent that it is no longer able to fulfill its vital functions. In this case, there is the possibility of liver transplantation. Transplantation of a healthy organ of a donor is a well-proven procedure which allows a long life with good quality of life.
Autoimmune hepatitis and primary biliary cirrhosis only very rarely require a liver transplantation, because either the clinical course is very slow, or because effective drugs are available. Primary biliary cirrhosis often runs a symptom-free course over a long period of time, even though in several patients it eventually leads to liver cirrhosis. Only if the functionality of the liver is severely impaired, transplantation is necessary and then is the best treatment method.
According to the individual disease additional drugs and methods are used. Therapies of autoimmune liver diseases nowadays are usually highly effective. However, these diseases are chronic diseases requiring permanent medical treatment. It is important to find the right doctors and to jointly decide on the right therapeutic strategies. Professional skills are as important in managing patients with autoimmune liver diseases as is mutual confidence. A good relationship between patient and doctor contributes to the success of therapy.