Autoimmune liver disease
Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC)
Autoimmune conditionTwo autoimmune liver diseases that mostly affect women: autoimmune hepatitis attacks liver cells, and primary biliary cholangitis attacks the small bile ducts.
What happens
In autoimmune hepatitis, immune cells inflame the liver tissue. In primary biliary cholangitis, the small bile ducts inside the liver are slowly destroyed, so bile backs up. Untreated, both can lead to scarring (cirrhosis). Both often respond well to treatment when they're found early.
Who gets it
Both are more common in women, especially primary biliary cholangitis, which usually appears between 40 and 60. Other autoimmune conditions such as thyroid disease and Sjögren's are common alongside them.
Common signs
- Fatigue
- Itchy skin, especially in primary biliary cholangitis
- Dry eyes and mouth
- Discomfort under the right ribs
- Yellowing of the skin or eyes
- Dark urine or pale stools
- Many people have no symptoms and are found through abnormal liver tests
Labs to ask about
- Liver enzymes (ALT, AST, ALP, GGT) and bilirubin
- Anti-smooth muscle antibodies, ANA, and IgG (autoimmune hepatitis)
- Anti-mitochondrial antibodies (primary biliary cholangitis)
- Liver ultrasound or elastography (a stiffness scan)
- Liver biopsy in some cases
How it's usually treated
- Autoimmune hepatitis: steroids and immune-suppressing medicines
- Primary biliary cholangitis: ursodiol, with newer second-line options
- Monitoring for scarring and bone loss
Supportive steps to discuss with your provider
- Limit alcohol.
- Ask before taking herbal supplements. Some, such as concentrated green tea extract, kava, and many weight-loss blends, can injure the liver.
- Check vitamin D and bone density.
- Get vaccinated for hepatitis A and B if you're not immune.
See a doctor promptly if you have
- Yellow skin or eyes
- Vomiting blood or black stools: go to the emergency room
- Confusion or unusual sleepiness
- A swollen belly or legs
Related conditions
Sjögren's disease
The immune system targets the glands that make tears and saliva, causing lasting dryness. It can also affect joints, nerves, and other organs.
Learn more →Hashimoto's thyroiditis
The most common cause of an underactive thyroid in the US. The immune system slowly damages the thyroid, so it makes less hormone over time.
Learn more →Celiac disease
An autoimmune reaction to gluten (in wheat, barley, and rye) that damages the lining of the small intestine and blocks nutrient absorption.
Learn more →
Wondering if your symptoms fit a pattern?
Dr. Lesher is a naturopathic doctor who specializes in women's autoimmune and chronic conditions. Since 2020, she has helped more than 900 patients overcome and heal from their conditions.