Tests and diagnosis
for autoimmune hepatitis
You might find out you have autoimmune hepatitis during tests for other health problems. If your GP suspects you have autoimmune hepatitis they will do some blood tests and then refer you to a liver specialist.
This will either be a hepatologist (a doctor who specialises in liver disease) or a gastroenterologist (a doctor who specialises in the digestive system).
They will try to find out what the problem is and how damaged your liver is. This will include a thorough medical history, physical examination, special blood tests and scans. Most people also need a liver biopsy. Blood tests, scans and biopsies are usually carried out at a hospital.
It is important to give your doctors as much information as you can. This includes other autoimmune diseases or health conditions you have. This will help them to diagnose your condition correctly and give you the right care. An early diagnosis can often mean your treatment will be more effective.
The information on this page is for:
- Adults with autoimmune hepatitis or suspected autoimmune hepatitis
- Family, friends, carers, and healthcare professionals.
On this page:
Tests
Blood tests
You could learn you have a liver problem from your doctor. This is usually the result of routine blood tests, which include liver blood tests (or liver biochemistry tests).
If you have autoimmune hepatitis, you will have more liver enzymes in your blood. These are alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
If your liver blood tests keep being abnormal, you will have further blood tests to identify autoantibodies.
Autoantibodies include:
- Anti-mitochondrial antibodies (AMA)
- Anti-nuclear antibodies (ANA)
- Anti-smooth muscle antibodies (ASMA).
you will also be tested for another type of antibody, called immunoglobulin G (IgG).
If you have autoimmune hepatitis, you will most likely have higher levels of these autoantibodies and IgG in your blood. IgG is used as a marker to monitor the effectiveness of your treatment.
Blood tests are an important guide to who might have liver disease. But they aren’t accurate enough to rule out liver disease by themselves. If your liver blood tests are abnormal it is important that your doctor investigates. This could include more blood tests, a scan and often a liver biopsy.
Scans
If liver disease is suspected, scans can give doctors a more detailed picture of what is going on. These can include the following:
- An ultrasound scan looks at the surface and general shape of your liver, as well as any changes from its normal appearance.
- Transient elastography eg FibroScan®, measures the stiffness of your liver and helps your doctor judge how much liver scarring (fibrosis) there might be.
- CT and MRI scans can look at your liver in more detail.
Read more about scans and imaging tests here.
Liver biopsy
Blood tests and scans are not usually enough to make a diagnosis. If there is any doubt your doctor will recommend a biopsy. This can check for inflammation and scarring of the liver (fibrosis) to find out how advanced your liver disease is.
Your doctor should explain the risks and why they think having a biopsy is a good idea. This will help you decide for yourself if you agree (consent) to have one.
A liver biopsy might be an option if you are not responding to treatment, or your doctor wants to stop it at a later date. They might suggest a liver biopsy to make sure your liver inflammation has improved or gone away (remission).
Read more about liver biopsy here.
There are often no signs that you have autoimmune hepatitis and symptoms can be vague. Blood tests and a liver biopsy are used to help confirm that you have it. Once you are diagnosed, we can help treat it.
Other tests if you have cirrhosis
Advanced liver disease is called cirrhosis. If you have or develop cirrhosis your clinical team will monitor your condition. You will be offered a clinical check-up every six months. They will also talk to you about any other tests or care you might need.
Endoscopy
You might have an endoscopy to look inside your food pipe (oesophagus) and stomach to check for swollen veins (varices). If the varices are large and at risk of bleeding, your liver specialist can place rubber bands around them to cut off their blood supply (banding).
Surveillance scan for liver cancer
Liver cancer is more common if you have cirrhosis. Finding it early means it can often be cured. Doctors use regular checks (surveillance) every six months. This is to check for a type of liver cancer called hepatocellular carcinoma.
Support
How Liver UK can help
A diagnosis of liver disease can be worrying, and you may have a lot of questions.
We're here for you and for your family and friends. Whether you have questions or just need someone to listen, we can help.
Your feedback
This content was last reviewed: June 2023
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Dr Vikki Gordon, University Hospitals Coventry and Warwickshire NHS Trust and Sue Eldred, Wye Valley NHS Trust. Ann Brownlee, Chair of Trustees, AIH Support. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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