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.
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
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.
Signs worth getting checked
- 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
Treatments your doctor may discuss
- 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
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.