About Autoimmune Diseases

The Liver Centre is fortunate that over time a large dedicated hepatology practice focused on autoimmune liver disease has developed under the auspices of Dr. Jenny Heathcote. This practice is now being continued by Gideon Hirschfield who has moved with his family from the UK to take a Staff position at the University. He has a broad internal medicine, gastroenterology and hepatology training. Initially a student of Oxford, then Cambridge University, he completed clinical training in London and Cambridge. His PhD was completed at the Royal Free, a hospital with a very rich Hepatology history, and specialist liver training was carried out at Addenbrookes hospital, Cambridge, a centre that pioneered liver transplantation.

The clinic sees a variety of patients with a wide spectrum of clinical problems. Apart from well diagnosed autoimmune liver disease we also offer a Consult service for the less common presentations of rarer liver diseases, from inherited problems (e.g. cholestasis, Wilson's) to structural ones (e.g. non-cirrhotic portal hypertension). We are now developing a close working relationship with Sick Kids Hospital, to create a formal transition hepatology service.

The bulk of our large clinic activity is spent looking after a number of liver diseases:

• Sclerosing cholangitis (an inflammatory attack on the large bile ducts)
• Autoimmune hepatitis (an immune attack on liver cells)
• Primary biliary cirrhosis (an immune attack on the small bile ducts)
• Autoimmune pancreatitis (an inflammatory attack on the pancreas and sometimes the liver)
• Overlap syndromes (where the target of the immune system is not clear)

These diseases are immune mediated illnesses where the body attacks the liver, either the bile ducts or the liver cells. The inflammation leads to scarring and long term liver damage. Unfortunately doctors still don't really understand why these diseases arise in the first place, and so we don't always have all the answers we need to treat the problems as well as we'd like. One of the reasons this clinic is so important is that in parallel to offering the best clinical service we can, we also strive to help research these diseases. For rarer diseases such as these it is only by gathering the expertise in one place that we can focus sufficient resources on the problem.

Patients come from all over Ontario (and sometimes further afield) to see us. We accept referrals direct from family physicians as well as specialists. When you come to clinic you can expect to have a first consultation where your history is carefully recorded, you are examined, and blood tests arranged. We rely heavily on the help of our colleagues in radiology (X-ray doctors: ultrasound and MRI in particular) as well as pathology (liver biopsy interpretation). We take all of the history, examination and tests into consideration when we reach a diagnosis, so that we can best advise our patients of what the problem is and what the optimal course of action should be. If we need the help of colleagues in other specialties we will let you know. We work closely with the Transplant doctors because some of our patients eventually find that they need a new liver to solve their problems. We all hope with time fewer and fewer patients will need to consider this.

Watch this space for more specific details for each disease! With time we'll fill the gaps…

Research fellowship positions are available with Dr. Hircshfield starting in July 2009. For further information, please click here.