| Autoimmune liver diseases are not well recognized in India due to overwhelming burden of alcohol and hepatitis B. Around 1.5% patients with chronic liver disease (CLD) have autoimmune liver disease. If alcohol, hepatitis B and C are excluded then autoimmune liver disease accounts for 10-15% in male patients with CLD and around 40-50% female patients with CLD. Amongst the autoimmune liver disease autoimmune hepatitis (AIH) remains dominant cause of CLD while primary biliary cholangitis (PSC) and primary biliary cirrhosis (PBC) remain in minority. AIH is seen across the age groups with predominant in young females. HLA sub-types are different in India as compared to western population. There is a sense that increasing incidence of autoimmune hepatitis in India. It is disease of commonly encountered in middle age with predominant female preponderance. There is high incidence of cirrhosis at presentation. Immunosuppression initiation is the key good long term outcome. Normalisation of ALT within 12 months after the initiation of the treatment should be the treatment goal. High mortality rates are encountered as compared to age matched control population. Disease progression can occur in spite of immunosuppression hence regular follow up is required. Liver transplantation is accepted modality of treatment in end stage liver disease due to AIH. Early diagnosis, appropriate treatment and regular follow up forms the corner stone of treatment of AIH. PBC remains uncommon disease and it is reported in the form of case series. PSC is rare disease and can be present with inflammatory bowel disease and 50% of the patients do not have inflammatory bowel disease. PBC patients are treated with ursodoxycolic acid have indolent course and detected in early stages. |
