Cirrhosis - Causes

Autoimmune Liver Disease

Autoimmune liver diseases include autoimmune hepatitis and primary biliary cirrhosis. Like other autoimmune disorders, these conditions most likely develop because a genetically defective immune system attacks the body's own cells and organs. People who have one of these liver diseases also often have other autoimmune conditions, including systemic lupus erythematosus, rheumatoid arthritis, Sjgren's syndrome, scleroderma, inflammatory bowel disease, glomerulonephritis, and hemolytic anemia.

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Autoimmune Hepatitis. Autoimmune chronic hepatitis occurs when an abnormal immune response causes an attack on the liver cells. It accounts for about 20% of all chronic hepatitis cases. Autoimmune chronic hepatitis typically occurs in women between the ages of 20 and 40 who have other autoimmune diseases. Some research indicates that the postmenopausal period may be another peak in incidence of AIH among women. About 30% of patients are men, however, and in both genders there is often no relationship to another autoimmune disease. In general, no major risk factors have been discovered for this condition.

Suspects for triggering this hepatitis include the measles virus, a hepatitis virus, or the Epstein-Barr virus, which causes mononucleosis. It is also possible that a reaction to a drug or other toxin that affects the liver also triggers an autoimmune response in susceptible individuals.

Click the icon to see an image of mononucleosis.

Primary Biliary Cirrhosis. Up to 95% of primary biliary cirrhosis cases occur in women, usually around age 50. In the case of primary biliary cirrhosis, the cells under attack from the aberrant immune system are in the bile ducts. Liver cells are destroyed as the disease progresses. In some cases, the disease also has features that resemble autoimmune hepatitis, but these features do not appear to affect the long-term outlook.

Some research indicates that this autoimmune process may be triggered by a virus or an unknown intestinal microorganism. People with celiac sprue appear to have a higher risk. This is an intestinal disorder associated with an inability to metabolize gluten, which is found in wheat and other common grains. Genetic factors are involved, but the inheritance pattern is unclear. A 1999 English study suggested that the disease is on the rise, although it is unclear if this reflects an actual increase or simply a greater awareness of the disorder.