Autoimmune hepatitis in a Jamaican cohort spanning 40 years

Roye-Green, Karen; Morris, Nathlee Mc; Dawson, Jacqueline E.; Whittle, Dwight; Barton, E N; Smikle, Monica

doi:10.3233/hab-140275

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…Until recently, the clinical course of pediatric AIH has been mainly described in patients of European origin (31,61,(65)(66)(67)(68)(69)(70), individuals from other ethnic groups being considered rarely affected by this condition. This notion, however, is proving incorrect, as AIH has been recently reported in a diverse range of populations (56,57,(71)(72)(73)(74)(75)(76)(77)(78). In the largest mostly European cohorts, the mode of AIH presentation includes (31,40,58,61,76,79):…”

Section: Clinical Featuresmentioning

confidence: 99%

“…As mentioned above, AIH is being increasingly reported in children and adolescents of non-Caucasoid descent, probably because the diagnosis of autoimmune liver disease was previously overlooked in view of the presence of epidemic viral hepatitis B and/or C. Reports from India (71,76), Malaysia (72), Pakistan (57), Bahrain (73), Iran (56), Egypt (78), Jamaica (77), Mexico (75) on cohorts including between 5 and 181 (median 34) patients indicate a clinical presentation and response to immunosuppressive treatment similar to those described in Caucasoid patients, but an overall worse response to treatment and outcome, possibly related to delay in referral to specialized centers and diagnosis.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Diagnosis and Management of Pediatric Autoimmune Liver Disease

Mieli‐Vergani

Vergani

Baumann

et al. 2018

J. pediatr. gastroenterol. nutr.

280

392

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Paediatric autoimmune liver disease is characterised by inflammatory liver histology, circulating autoantibodies and increased levels of IgG, in the absence of a known etiology. Three conditions have a likely autoimmune pathogenesis: autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC), and de novo AIH after liver transplantation. Two types of paediatric AIH are recognized according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA, AIH-1) or liver kidney microsomal type 1 and/or anti-liver cytosol type 1 antibodies (anti-LKM-1/anti-LC-1; AIH-2).Pertinent issues addressing the diagnosis, treatment and long term follow up were formulated by a core group of ESPGHAN members. They have commissioned the first authors with execution of this project. Initially, they have performed a systematic literature search on MEDLINE, ResearchGate and Mendeley databases over the last 30 years and produced a document focusing on prospective and retrospective studies in children. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using a formal voting technique.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Diagnosis and Management of Pediatric Autoimmune Liver Disease

Mieli‐Vergani

Vergani

Baumann

et al. 2018

J. pediatr. gastroenterol. nutr.

280

392

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“…До недавнего времени клинические проявления АИГ у детей в основном описывались у пациентов европейского происхождения [24,[27][28][29][30][31][32][33], причем это заболевание редко встречалось у людей из других этнических групп. Однако, исходя из недавних исследований, это утверждение оказалось неверным [33][34][35][36][37][38][39][40][41][42][43].…”

Section: клиническо-лабораторные проявления аутоиммунного гепатита у unclassified

“…Как упоминалось выше, АИГ все чаще диагностируется у европейских детей и подростков, вероятно, потому что диагноз аутоиммунного заболевания печени пропускался из-за выявления вирусных гепатитов В и С. Исследования в группах от 5 до 181 (в среднем 34) пациентов, проводившиеся в Индии [35,42], Малайзии [39], Пакистане [38], Бахрейне [37], Иране [36], Египте [34], Ямайке [43], Мексике [41], -указывают на клинические проявления и ответ на иммуносупрессивную терапию, сходный с таковым у европейских пациентов, но в целом более худший ответ на лечение и исход заболевания, вероятно, был связан с поздней диагностикой и задержкой направления пациентов в специализированные центры.…”

Section: клиническо-лабораторные проявления аутоиммунного гепатита у unclassified

Autoimmune Hepatitis in Children: The Current State of the Problem

Волынец

Хавкин

Skvortsova

et al. 2018

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim.To generalize the results of existing research studies carried out to investigate autoimmune hepatitis (AIH) in children, and the contemporary approaches to the diagnosis and therapy of the disease. Key points. According to the results of serological studies, two types of AIH can be distinguished in children. AIH of type 1 is diagnosed, when anti-smooth muscle autoantibodies (ASMA) and/or antinuclear autoantibodies (ANA) have been detected. AIH of type 2 AIH is diagnosed, when liver kidney microsomal autoantibodies (anti-LKM-1) and/ or anti-liver cytosolic autoantibodies (anti-LC-1) have been detected. Liver parenchymal inflammation responds well to a standard immunosuppressive therapy with prednisolone and azathioprine. Disease relapses are observed in about 40% of patients during treatment. It is expedient to treat children at least for 2–3 years before attempting to cancel the treatment, which decision should be considered only when the levels of transaminases have remained normal and IgG has been negative, or autoantibody titers have been low (1:20 using immunofluorescence method) for at least a year. Before attempting to cancel the therapy, liver biopsy and histological study should be repeated in order to exclude the possibility of residual inflammatory changes. For a small number of patients, who do not respond to standard treatment and those who suffer from frequent disease relapses, it is advisable to offer an alternative immunosuppressive treatment, the effectiveness of which is still ambiguous and poorly understood (including, in order of priority, mycophenolate mofetil, calcineurin inhibitors, rituximab, Inhibitor of tumor necrosis factor-alpha). In cases of refractoriness to therapy and the disease progression to liver cirrhosis and its decompensation, liver transplantation is justified. It is shown that AIH might relapse after liver transplantation. De novo AIH develops after liver transplantation as a result of non-autoimmune diseases; it is characterized by the presence of autoantibodies (ANA, ASMA and typical or atypical anti-LKM-1), and histologically characterized by a pattern similar to that of AIH. De novo AIH after liver transplantation responds well to a classical immunosuppressive therapy, but not to a standard antiretroviral therapy. In the review, we discuss issues associated with the clinical manifestations and diagnosis of AIH in children. Approaches to the treatment and long-term observation of such children are reviewed, including, i.e., those formulated by the main group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) members.Conclusion. Autoimmune hepatitis (AIH) in children has a progressive course with the outcome to liver cirrhosis. The presented review has summarized approaches to the diagnosis and selection of AIH therapy in children.

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“…In Bezug auf die Ausprägung und Prävalenz der Erkrankung bestehen regional und ethnisch große Unterschiede [204,224]. Patienten mit AIH haben im Vergleich zu einer europäischen Referenzpopulation eine erhöhte Mortalität [120,121].…”

Section: Kommentarunclassified