Xiao Xiao Ma Xiong 1. What is autoimmune liver disease? Autoimmune liver disease is a chronic hepatobiliary injury caused by the body’s immune system attacking its own liver components. Normally, the immune system is the body’s bodyguard, helping the body to resist and remove foreign substances. When the immune system is disturbed or the liver tissue components are abnormal, the immune system mistakes its own liver tissues for foreign substances, resulting in a situation where “one’s own people fight one’s own people”. Depending on the tissue components attacked, autoimmune liver diseases can be divided into those with predominantly hepatocellular damage, namely autoimmune hepatitis (AIH), and those with predominantly intrahepatic bile duct damage, namely primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). In addition, the simultaneous occurrence of any two of these three diseases is an overlap syndrome, mainly AIH-PBC overlap syndrome. Ma Xiong, Department of Gastroenterology, Shanghai Renji Hospital 2. How is autoimmune liver disease diagnosed? To diagnose autoimmune liver disease, firstly, we need to exclude hepatitis virus infection and liver damage caused by alcohol and drugs. Secondly, a diagnosis can be made only after a comprehensive analysis of clinical manifestations, liver biochemical tests, autoantibody and immunoglobulin tests, imaging tests and liver histopathological manifestations. It is important to determine which type of autoimmune liver disease the disease belongs to in order to select the right treatment medication.3. How to treat AIH The standard treatment of AIH is based on glucocorticoids (prednisolone) and the dose of hormone is individualized. Because AIH is prone to recurrent attacks, the treatment course usually needs to last for more than 3 years. To reduce recurrence and avoid side effects of glucocorticoids, azathioprine can be used as maintenance therapy after remission.4. How to treat PBC The standard treatment for PBC is based on ursodeoxycholic acid at a dose of 13-15 mg/kg/day. Because PBC is a chronic disease, patients need to take adequate doses of ursodeoxycholic acid for a long time to maintain treatment. In addition, patients with PBC are prone to osteoporosis and should take vitamin D and calcium supplements routinely.5. How is AIH-PBC overlap syndrome treated? AIH-PBC overlap syndrome is treated with a combination of glucocorticoids and ursodeoxycholic acid due to the presence of both hepatocellular damage and cholestasis.6. What is the prognosis of autoimmune liver disease? Autoimmune liver disease can improve significantly with regular treatment. The survival of early stage patients and those with AIH who respond well to treatment is not different from that of normal subjects. With the development of testing technology and the experience of clinicians, most patients with PBC do not progress to cirrhosis at the time of definitive diagnosis, and early and long-term adequate treatment of PBC patients can maintain disease stability. What are the side effects of glucocorticoid therapy? The long-term use of large amounts of glucocorticoids may cause side effects such as increased blood pressure and blood sugar, osteoporosis, and gastrointestinal bleeding. However, the dose of hormones used in the treatment of autoimmune liver disease is small, and only a few patients may experience these side effects. Paying attention to monitoring blood pressure and blood sugar, protecting gastric mucosa, and supplementing with vitamin D, calcium and acid suppressants during hormone therapy can reduce the occurrence of the above side effects.8. What is liver biopsy? Liver biopsy is a test that can directly understand the pathological changes of tissues and make a more accurate diagnosis, which is recognized as the “gold standard” and its diagnostic value is much higher than the diagnostic value of blood biochemistry and imaging. Liver biopsy is particularly important for the diagnosis of autoimmune liver disease with atypical blood biochemistry, and can detect fibrosis or early compensated cirrhosis, and has an irreplaceable role in determining the course of treatment and prognosis of the disease.9. Is autoimmune liver disease contagious? Autoimmune liver disease is an autoimmune disease, not caused by hepatitis virus infection, therefore it is not contagious.10. What should I pay attention to in the diet of autoimmune liver disease patients? Patients with autoimmune liver disease should not eat a high-fat diet, such as fatty meat, animal offal, etc. They should not take tonic drugs or prescriptions with unknown ingredients, and should eat less mushrooms and celery, etc. They should eat high-protein foods such as fish, shrimp, lean meat, fresh fruits and vegetables.