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Liver Biopsy w/Autoimmune Hepatitis/How often should it be done?

Posted by Patrice on June 14, 1999 at 22:44:09
Hi Doctor,
I am 33yrs old I have 3young children.  I was diagnosed with automimmune hepatitis with "early cirrhosis" in October,1991.  I have since been on prednisone.  But I havent had a liver biopsy since.  I deal with a lot of side effects, such as bruising, extreme nausea, diarrhea, mild itching, severe fatigue etc.  I was just diagnosed with osteoporosis of the spine and right hip.
But its going on eight years now and every story that Ive read about has had a repeated biopsy within a couple of years.  I cannot figure out why my doctor has not requested another biopsy to be performed to see what stage the cirrhosis is in now.  I really want to know.  I feel so blind about my disease.  I have been diagnosed with gallstones, and bacteria in my stomach or g.i. tract which I had to take a load of antibiotics twice a day.  I think that if I wasnt suffering from so many side effects it wouldnt make too much difference to me to have another biopsy, but because I am, and a lot of doctors have never heard of autoimmune hepatitis. Lately Ive been very lightheaded also.  Please send any info.  Thanks a bunch.

Posted by HFHSM.D.-D.M. on June 27, 1999 at 15:36:49
Dear Patrice:
I was very intrigued by your situation and your questions.  It sounds like you acute hepatitis in 1991, were diagnosed with autoimmune hepatitis and early cirrhosis and have been on treatment ever since.  You now want to know if you should have another biopsy.
As a general rule, there are a couple of different ways to follow someone with autoimmune hepatitis.  The most common way that we follow someone is watching the liver enzymes.  The liver enzymes tests are blood tests and as a result are relatively convenient for the patient and physician.   If someone has markedly elevated liver enzymes from autoimmune hepatitis and their liver enzymes return to normal with treatment, we feel they are responding to treatment.  I can't absolutely guarantee that someone with autoimmune hepatitis who has normal liver enzymes on treatment will not have progressive disease, but experience tells us that the liver enzymes are pretty good markers especially when you factor in their safety and convenience.
We can follow autoimmune hepatitis with periodic liver biopsy's and there are circumstances in which we do this.  The liver biopsy is certainly less convenient than blood tests and there is a chance of bleeding with this procedure.  Moreover, once someone has cirrhosis, the liver biopsy is not always a great test for looking at differences in levels of cirrhosis.  There are often clinical signs or other blood tests that are good tests that the cirrhosis is getting worse.  
I hope this answer is not too confusing for you.  Clearly, you and your physician will have to make decisions together where to proceed from here.  It sounds like your physician is pretty thoughtful.  If you are not sure what to do, you might want to get a second opinion.  I am sure your physician won't mind.  I do want to stress that a lot of recent data suggests that individuals with autoimmune hepatitis who have early cirrhosis on biopsy can do well for a long time with good treatment.  In a worse case situation, people with autoimmune hepatitis typically do very well with liver transplant.  
I hope this information is helpful to you. Good luck with your situation.  Feel free to let me know if you have additional questions or information by posting them to MedHelp.  The direct number to our Liver Clinic at Henry Ford at (313) 916-8865. We have an active group of liver specialists with experience with autoimmune hepatitis.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.

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