Diagnosis and Management of Autoimmune Hepatitis

Abstract

This guideline has been approved by the American Association for the Study of Liver Diseases (AASLD) and represents the position of the Association. 1. Preamble Clinical practice guidelines are defined as ''systematically developed statements to assist practitioner and patient decisions about appropriate heath care for specific clinical circumstances.'' 1 (All references are available in the Supporting Information.) These guidelines on autoimmune hepatitis provide a data-supported approach to the diagnosis and management of this disease. They are based on the following: (1) formal review and analysis of the recently-published world literature on the topic [Medline search]; (2) American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines; 2 (3) guideline policies, including the AASLD Policy on the Development and Use of Practice Guidelines and the American Gastroenterological Association Policy Statement on Guidelines; 3 and (4) the experience of the authors in the specified topic. These recommendations, intended for use by physicians, suggest preferred approaches to the diagnostic, therapeutic and preventive aspects of care. They are intended to be flexible, in contrast to standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based on relevant published information. To more fully characterize the quality of evidence supporting the recommendations, the Practice Guidelines Committee of the AASLD requires a class (reflecting benefit versus risk) and level (assessing strength or certainty) of evidence to be assigned and reported with each recommendation. 4 The grading system applied to the recommendations has been adapted from the American College of Cardiology and the American Heart Association Practice Guidelines, and it is given below (Table 1).

Role of Allopurinol in Optimizing Thiopurine Therapy in Patients with Autoimmune Hepatitis: A Review

“…1 There is a marked heterogeneity in presentation from asymptomatic elevation of transaminases to acute liver failure to cirrhosis. [2][3][4] 1,4 Type I AIH is more common and seen predominantly in adults while type II AIH is more frequently seen in young children. The diagnosis of AIH is based on the revised or simplified diagnostic criteria, with the revised diagnostic criteria being more suited for patients with atypical features.…”

“…normal levels of transaminases, IgG and gamma globulin and absence of inflammation on liver histology. 4 In children, prednisone is given at a dose of 1-2 mg/kg/day (max of 60 mg day) and AZA at 1-2 mg/kg/day or 6-mercaptopurine (6MP) at 1.5 mg/kg/ day. 4 Both the induction regimens of prednisone alone vs. prednisone and AZA have been shown to be equally effective in a systematic review of randomized controlled trials.…”

Role of Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis—An Observational Study

“…Patients were diagnosed with AIH according to internationally agreed Hennes criteria. 1,2,13 Patients included in the study were all patients with a diagnosis of AIH from the ages of 18 years onwards identified from the database. Patients were excluded from the study if they had co-existent liver diseases including: chronic hepatitis C infection, chronic hepatitis B infection, alcoholic liver disease as defined by an alcohol consumption >40 g alcohol/day in females and >60 g alcohol/day in males, fatty liver disease, previous liver transplantation, or hepatocellular carcinoma.…”

“…Treatment response was assessed based on clinical symptoms and biochemical parameters such as AST, ALT and IgG levels as defined by agreed criteria. 13 These were assessed at clinic visits. Drug compliance and adverse events were checked during every clinic visit by direct questioning.…”

Nonalcoholic Fatty Liver Disease in Patients with Autoimmune Hepatitis: Further Reason for Teeth GNASHing?

“…Standard treatment of AIH is comprised of induction therapy (usually with prednisone or prednisolone) and maintenance treatment with a steroid-sparing agent, mostly azathioprine or 6-mercaptopurine [4,7]. Induction treatment with high-dose steroids will worsen diabetes and degrade the metabolic state of the patients by causing additional weight gain.…”