British Liver Trust
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AIH & LFT's

Hi I'm new to here, so firstly hello to everyone.

I recently was tested for Coeliac/B12 & intrinsic factor as I had been feeling very tired all the time and we have a family history of B12 deficiency, coeliac and migraines.

All the results were clear however as part of the testing another result came back that my blood was positive for SMA's and advised I should be referred to a gastroenterologist for AIH. My LFT's are fine, my question is can you still have AIH even though your LFT's are normal?

This is all new to me and I don't have any values to put against the tests as this is all the information I have at the moment.

Thanks in advance for shedding light on this for me.

Roger

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I think the general gist of things seems to be that you can have normal LFTs with many liver diseases. The LFTs your GP generally takes tend to show if there is an ongoing or recent liver injury. If they are within the normal range then it may just mean that the disease wasn't very active at that moment in time. I know a number of liver diseases can have "flares" when they are more active than others. Similar i suspect to some rheumatic diseases.

I'm not sure if AIH operates in this way, but it does sound plausible. BLT have a page about AIH and a leaflet. The link is below.

britishlivertrust.org.uk/li...

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Thanks for the reply Kristian and what you say about the LFT's makes sense if it's a snapshot of what your liver is doing at that point in time. I assume the appointment with the gastroenterologist will go through the next steps forward

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They will indeed. Good luck with the appointment and hope all turns out well.

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Yes you can.

AIH means your immune system is attacking your liver. The attack causes inflammation (hepatitis). If the amount of hepatitis is greater than the liver's usual repair mechanism can deal with, then left unchecked the hepatitis eventually resolves to fibrosis (scar tissue).

If the process continues long enough the fibrosis will extend throughout the liver - which is commonly called cirrhosis but the liver will still manage to carry out its functions (compensated cirrhosis). At some point following that the liver will be unable to perform its functions properly (decompensated cirrhosis).

The good thing about AIH is that it is very treatable with immunosuppression. Essentially, if you haven't reached the point past early cirrhosis then immunosuppression will hopefully reduce any inflammation to a level below the ability of the liver to repair itself. IF that is the case then the AIH will be kept at bay and the level of fibrosis minimised.

I have AIH and Cirrhosis and normal LFTs - the meds seem to be keeping things ticking over nicely. IF it had been discovered before extending to full cirrhosis then it is likely that the immunosuppression may have allowed the liver time and space from hepatitis to fully recover from the fibrosis.

Hopefully in your case it's been caught early - but even if not - it is treatable, but must be taken seriously.

Very best wishes.

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Thanks MisterX, that's great information and very valuable it being from someone who has AIH.

Hopefully mine has been caught early enough that little or no damage has been done, I'll see what the gastroenterologist says when I get my appointment through.

Thanks again and glad the immunosuppressive meds work well for you 👍🏻

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A naive and optimistic question, is there any chance that the blood test that has indicated AIH (sma's) is wrong or are they fairly accurate?

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Postivity for SMA isn't a definitive test for AIH. SMA antibodies can be found in numerous liver disorders and just indicate there is some immune system activity. A diagnosis of AIH is often based on numerous tests including blood tests, liver biopsy and scans plus in general it only comes to light when the inflammation is ongoing (high ALT) and another method of diagnosis is a positive reaction to steroids.

You will require further exploration no doubt but the AIH diagnosis at this stage is no where near confirmed and I hope you get some answers very soon.

Katie

p.s. my hubby has cirrhosis due to AIH (they believe). He had cirrhosis before they knew there was anything wrong with his liver at all. Biopsies proved cirrhosis but suggestion is his AIH is burned out. Normal LFT's at this stage and no ongoing inflammation.

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Thanks for your reply Katie, I'm new to all this so I'm aware of asking naive questions but obviously not as naive as I thought.

So if I understand correctly, what you are saying is, I do have a condition in my liver but it's based on the other tests what type/name it is?

I am fine with whatever the results as after chatting on here has really put my mind at ease.

Thanks again and hope your hubby continues to stay well 👍🏻

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Having normal LFT's (in the case of AIH) would indicate you have no ongoing inflamation in the liver or your ALT (Alanine aminotransferase) level would be raised. In AIH this can read into the thousands and it would show that the condition is flaring or not under control - this is the stage when most people undergo investigation for Auto Immune Hepatitis.

You may have nothing at all going on in your liver just now, your fatigue may be down to something completely different. It would be very unusual to have active AIH which is causing symptoms with no out of range blood results.

All you have just now is the presence of a 'rogue antibody' which at present might be doing nothing at all or yes might be an indicator that something is awry somewhere - diagnosis is very much best left to doctors.

No question is a daft one and its how we all learn.

Hubby is up and down with his condition, chronic fatigue is his main issue together with sleep deprivation and issues more to do with his cirrhosis rather than AIH - he never knowingly had any symptoms of that.

Katie

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Thank you again Katie.

I've just had my gastro appt through, it's for the 26th Feb 2018 so I think I'll just try and put it out of my mind for now.

I am also under investigation for sleep apnea at the moment (which my girlfriend is convinced I have), so it could possibly this is more down to my fatigue than anything in my liver.

Thanks again, Roger

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Hi, yes the LFT can be totally normal and you have AIH. The SMA is a very sensitive test and pretty good indication that you have AIH if this shows up, but.... you have to have liver biopsy to be certain. This is my understanding from my doctors.

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