Brief Answer:
Safer steroid(budesonide) can be effective.

Detailed Answer:
Hello XXXX

I understand your concern.

In my opinion,the following are best alternate options..

1)Autoimmune hepatitis responds well to steroids..Modern steroids like budesonide which have lesser side effect profile compared to conventional old steroid(prednisone).Another advantage being its effectiveness which is more or less equal to the prednisone..

If i am your treating doctor,would advise you with initially a lowest effective dose of 6mg/day for one month
(I will oberve whether you are tolerating this without any significant reactions and also change the regimen as needed)

Note: Mild aggravation of symptoms can be seen initially.This can be overcome with appropriate supportive measures

2)Oral azathioprine tablet(Non-steroidal immunosuppressant) which is less effective compared to steroids.A daily dose of 30-50mg/day to start with can be considered..Gradual tapering of dose over weeks is needed until maintenance dose is reached..

3)If there are no signs of improvement i.e not responding to conventional immunosuppressive therapy(like with above two options)--->Drug Mycophenolate moeftil(oral capsule 1gram/day) is to be considered..


Yes.I wanted to say that it would be better to rule out any undetected bile tract blockage with ERCP or MRCP,which was not seen in biopsy specimen.

Bile tracts(Biliary system) of the liver carries the bile juice produced in liver and finally stores it in the gallbladder.When these tracts are inflammed or blocked,bile juice transport gets interrupted and thus the contents of it like bilirubins,lipids(cholesterol) gets absorbed into the blood.This can also lead jaundice(Yellowness),pruritis(itching) etc.


Please discuss this with your treating doctor and initiate the appropriate treatment that best suits you..

If any further clarifications,hope to answer you..

Regards

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Brief Answer:
Yes,takes care of inflammation.

Detailed Answer:
Hello XXXX

I will try to explain as much I can for your easy understanding..

Normally our body is immune to foreign agents that are exposed from external environment.

But in autoimmune conditions,due to unclear reasons our body's immune system gets overactivated and starts to attack our own tissues.

Factors like genetically predetermined tendency for autoimmunity,history of infections(bacterial or viral commonly),toxin or even drug's exposure are believed to be involved.

In autoimmune hepatitis,body's immune cells(white cells) mainly T- and B-lymphocytes starts to attack the hepatocytes(liver cells) both directly and by production of antibodies.This causes cellular death(necrosis) and reactive inflammation of adjacent liver tissue.When these processes are not controlled,this can increase the extent of both the hepatocellular damage and associated fibrosis(i.e regions of cellular necrosis would gradually then be replaced by fibrous tissue mainly composed of collagen).

Immunosuppressants like steroids,azathioprine etc suppress this unwanted immune overactivity (here in the liver tissue) through many mechanisms.

1)Prevents the migration and overactivation of immune cells..
2)Reduces fibrosis
3)Prevents the production of chemicals(mediators) that induce inflammation
and many more..

So direct cellular injury and indirect injury(by production of autoantibodies) can be controlled with these drugs.Ultimately inflammation starts resolve and the disease progress slows down with the treatment.

The treating doctor would advise periodic liver function tests(ALT,AST,bilirubin etc) and a follow up liver biopsy after a year to assess the treatment efficacy.

Hope this information helps you..

If any doubts,get back to me..

Regards..

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Brief Answer:
Won't cause cancer or any other unknown illnesses..

Detailed Answer:
Hello XXXX

You need not be worried as this steroid drug budesonide is relatively safe..

Especially at dose 6mg a day wouldn't cause cancer or any other complications as you think..

Cactus juice may be helpful in resolving the liver inflammation.But to control or treat the root cause of liver inflammation and damage,immunosuppressants are required.

Its better to avoid or limit cactus juice prior to starting with the immunosuppressive therapy to avoid any significant interactions and also a possible reduction in treatment efficacy..

A trial of immunosuppressive therapy is the best choice for you.

No need to get worried of this and you may even update me the progress with reports,queries etc anytime..

I will be available to assist you anytime.

Hope i have answered your query.If any clarifications,get back to me or else close the discussion and rate my answer.

Wish you good health.

Regards
Dr.N.Senduran

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Brief Answer:
Unfortunately can't prescribe you the drug..

Detailed Answer:
Hello XXXX.

You may be put on a course of budesonide(6mg once a day) for a minimum of 1 month and to maximum duration of 3 months or any shortest duration of time until remission..The duration of treatment may vary depending on your tolerance and also how you are responding to the treatment.

As such budesonide at low dose doesn't seem to affect the pregnancy.Higher doses of steroids can be associated with significant influence on growth of the fetus.However i would not recommend to take the drug in pregnancy especially during first trimester on safer side.

There is no provision to prescribe medications here.These informations are intended only to guide you in right direction.You need to discuss this with your treating doctor or an immunologist for the prescription.

Hope this helps you..

Regards..

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Brief Answer:
Most likely you have autoimmune hepatitis

Detailed Answer:

Hello XXXX

My opinion is that you probably have either
1)Autoimmune hepatitis
(or)
2)Primary sclerosing cholangitis-autoimmune hepatitis overlap syndrome (PSC/AIH syndrome)

Regarding best initial management ----Immunosuppressant therapy as already discussed.

Hope i have answered your question.

Get back to me,if you have further doubts..

Regards

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