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Overview of clinical presentation and diagnosis of autoimmune hepatitis in a single, referral center

Denitsa Dukova, Iskren Kotzev

Abstract

BACKGROUND AND AIMS: The diagnosis of autoimmune hepatitis (AIH) is often difficult because of the large heterogeneity of its clinical, laboratory and histological features and the absence of a specific diagnostic test. This study aims to determine the demographic, clinical, biochemical and serological characteristics and histological findings of AIH and to what extent they correspond to the International Autoimmune Hepatitis Group (IAIHG) diagnostic criteria.

METHODS: Retrospective analysis of the adult patients diagnosed as AIH at our clinic from January 2005 to December 2013 was performed. Demographic, laboratory, clinical and histological data of the patients were collected and a score was calculated for each patient based on the IAIHG revised and simplified scoring system. Only pretreatment scores were analyzed.

RESULTS: 57 patients were diagnosed as AIH on clinical grounds (mean age: 50 years, range: 19-74), from which 82.5% were women. 49.1% were asymptomatic, 10.5% had acute hepatitis, and 40.3% had chronic liver disease. The most common symptoms at presentation were fatigue (24.6%), icterus (21.1%) and dark urine (19.3%). 28.1% of patients had cirrhosis at presentation. Elevated IgG levels were detected in 75% of cases. ANA, ASMA, ALKM and pANCA were positive in 75.0%, 54.5%, 6.5% and 25.0% of patients respectively. Liver biopsy was performed in 42.1% of the patients. 84% of patients diagnosed with AIH according to clinical judgment of the treating physician were also diagnosed with AIH according to the revised and simplified criteria.

CONCLUSIONS: The majority of patients satisfy the original or simplified criteria and these criteria are
useful in the diagnosis.


Keywords

autoimmune hepatitis; scoring systems; diagnosis; clinical presentation; laboratory features

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References

Czaja AJ, Manns MP. Advances in the diagnosis, pathogenesis, and management of autoimmune hepatitis. Gastroenterology. 2010;139:58-72 e54.

Manns MP, Czaja AJ, Gorham JD, Krawitt EL, Mieli-Vergani G, Vergani D, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:2193-2213.

K. M. Boberg EAJJ. Incidence and Prevalence of Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis, and Autoimmune Hepatitis in a Norwegian Population. Scandinavian journal of gastroenterology. 1998;33:99-103.

Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. Journal of hepatology. 1999;31:929-938.

Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48:169-176.

Czaja AJ. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis. Hepatology. 2008;48:1540-1548.

Kil JS, Lee JH, Han AR, Kang JY, Won HJ, Jung HY, et al. Long-term treatment outcomes for autoimmune hepatitis in Korea. Journal of Korean medical science. 2010;25:54-60.

Li Y, Peng M, Gong G. Evaluation of the revised versus the simplified scoring system in patients with autoimmune hepatitis. Experimental and therapeutic medicine. 2014;7:131-136.

Kim BH, Kim YJ, Jeong SH, Tak WY, Ahn SH, Lee YJ, et al. Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: A nationwide, multicenter study. Journal of gastroenterology and hepatology. 2013;28:128-134.

Czaja AJ. Comparability of probable and definite autoimmune hepatitis by international diagnostic scoring criteria. Gastroenterology. 2011;140:1472-1480.

Kim T, Kagihara J, Tsai N, Roytman M. Tu1833 Autoimmune Hepatitis in Hawaii. Gastroenterology. 2014;146:S-1008.

Garcia-Torres ML, Primo J, Ortuno JA, Martinez M, Anton MD, Zaragoza A, et al. (A clinical study of adult autoimmune hepatitis in Valencia, Spain). Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2008;100:400-404.

Werner M, Prytz H, Ohlsson B, Almer S, Bjornsson E, Bergquist A, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a

nationwide study. Scandinavian journal of gastroenterology. 2008;43:1232-1240.

Choudhuri G, Somani SK, Baba CS, Alexander G. Autoimmune hepatitis in India: profile of an uncommon disease. BMC gastroenterology. 2005;5:27.

Floreani A, Niro G, Rosa Rizzotto E, Antoniazzi S, Ferrara F, Carderi I, et al. Type I autoimmune hepatitis: clinical course and outcome in an Italian multicentre study. Alimentary pharmacology & therapeutics. 2006;24:1051-1057.

Muratori P, Granito A, Quarneti C, Ferri S, Menichella R, Cassani F, et al. Autoimmune hepatitis in Italy: the Bologna experience. Journal of hepatology.

;50:1210-1218.

Jalihal A, Telisinghe PU, Chong VH. Profiles of autoimmune hepatitis in Brunei Darussalam. Hepatobiliary & pancreatic diseases international : HBPD INT. 2009;8:602-607.

Debbeche R, Maamouri N, Ajmi S, Azzouz MM, Ben Mami N, Dougui MH, et al. (Autoimmune hepatitis in Tunisia. Retrospective multicenter study of 83 cases). La Tunisie medicale. 2010;88:834-840.

Malekzadeh Z, Haghazali S, Sepanlou SG, Vahedi H, Merat S, Sotoudeh M, et al. Clinical features and long term outcome of 102 treated autoimmune hepatitis

patients. Hepatitis monthly. 2012;12:92-99.

Gronbaek L, Vilstrup H, Jepsen P. Autoimmune hepatitis in Denmark: Incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. Journal of hepatology. 2014;60:612-617.

Moura MC, Nunes AT, Pereira E, Araújo JP, Meirinho I, Dias C, et al. 939 Autoimmune Hepatitis in Hospitalized Patients: Case Series Report of Patients

Admitted to an Internal Medicine Department. Journal of hepatology. 2012;56:S366-S367.

Boberg KM, Chapman RW, Hirschfield GM, Lohse AW, Manns MP, Schrumpf E, et al. Overlap syndromes: the International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue. Journal of hepatology. 2011;54:374-385.

Chen J, Eslick GD, Weltman M. Systematic review with meta-analysis: clinical manifestations and management of autoimmune hepatitis in the elderly. Alimentary pharmacology & therapeutics. 2014;39:117-124.

Seo S, Toutounjian R, Conrad A, Blatt L, Tong MJ. Favorable outcomes of autoimmune hepatitis in a community clinic setting. Journal of gastroenterology

and hepatology. 2008;23:1410-1414.

Abdollahi MR, Somi MH, Faraji E. Role of international criteria in the diagnosis of autoimmune hepatitis. World journal of gastroenterology : WJG.

;19:3629-3633.

Miyake Y, Iwasaki Y, Sakaguchi K, Shiratori Y. Clinical features of Japanese male patients with type 1 autoimmune hepatitis. Alimentary pharmacology & therapeutics. 2006;24:519-523.

Teufel A, Weinmann A, Kahaly GJ, Centner C, Piendl A, Worns M, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. Journal of clinical gastroenterology. 2010;44:208-213.

Abe K, Katsushima F, Kanno Y, Takahashi A, Yokokawa J, Ohira H, et al. Clinical features of cirrhosis in Japanese patients with type I autoimmune hepatitis. Internal medicine (Tokyo, Japan). 2012;51:3323-3328.

Zachou K, Muratori P, Koukoulis GK, Granito A, Gatselis N, Fabbri A, et al. Review article: autoimmune hepatitis -- current management and challenges.

Alimentary pharmacology & therapeutics. 2013;38:887-913.




DOI: http://dx.doi.org/10.14748/ssm.v46i2.678
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About The Authors

Denitsa Dukova
Saint Marina university hospital of Varna
Bulgaria

Clinic of hepatogastroenterology

Iskren Kotzev
Medical university of Varna

Clinic of hepatogastroenterology

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