Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease

Luca-Johnson, Javier De; Wangensteen, Kirk J.; Hanson, Joshua A.; Krawitt, Edward L.; Wilcox, Rebecca

doi:10.1007/s10620-016-4213-3

Cited by 70 publications

(71 citation statements)

References 21 publications

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“…No other histologic features of NASH, including the diagnosis of definite steatohepatitis, hepatocellular ballooning, lobular inflammation, or advanced fibrosis, differed from those without autoantibodies. As indicated by other investigators, the International Autoimmune Hepatitis Group scoring system may not be effective in distinguishing autoimmune hepatitis from NAFLD/NASH in an individual with autoimmune antibodies and clinical features of NAFLD; it is these individuals who specifically benefit from biopsy analysis prior to initiation of treatment …”

Section: Liver Biopsy Evaluation In Patient Care Considerationsmentioning

confidence: 98%

Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation

Brunt¹

2017

Hepatology Communications

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Nonalcoholic fatty liver disease (NAFLD) is one of the most common underlying causes of chronically elevated liver tests and liver disease in adults and children worldwide and may be strongly suspected if not diagnosed by ever evolving and available serologic and imaging‐based noninvasive tests. However, the definitive diagnosis of the most progressive form of NAFLD, nonalcoholic steatohepatitis, and the identification of fibrosis stage still require liver biopsy evaluation as noninvasive testing has not replaced some of the specifics or the totality of information obtainable from liver biopsy. In this review, both the role and value of a liver biopsy evaluation in NAFLD/ nonalcoholic steatohepatitis are examined from publications related to a selected variety of settings. Details of the most commonly used semiquantitative methods of analysis are discussed, and some useful potential pitfalls for differential diagnostic consideration in liver biopsy interpretation are given. (Hepatology Communications 2017;1:370–378)

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Section: Liver Biopsy Evaluation In Patient Care Considerationsmentioning

confidence: 98%

Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation

Brunt¹

2017

Hepatology Communications

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“…Patients with coincident AIH and nonalcoholic steatohepatitis (NASH) are more likely to present with cirrhosis and more likely to develop an adverse clinical outcome with poorer survival compared to AIH without coincidence of NAFLD/NASH 51. This finding suggests that the simultaneous presence of AIH and NASH may confer an increased risk of progressive liver disease and death.…”

Section: Diagnosis and Management Of Atypical Aihmentioning

confidence: 99%

Autoimmune hepatitis: current challenges and future prospects

Aizawa¹,

Hokari²

2017

CEG

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Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by high levels of aminotransferases and autoantibodies, hypergammaglobulinemia, and interface hepatitis. AIH affects all races and all ages worldwide, regardless of sex, although a preponderance of females is a constant finding. The etiology of AIH has not been completely elucidated, but immunogenetic background and environmental parameters may contribute to its development. The most important genetic factor is human leukocyte antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of AIH. The diagnosis of classical AIH is fairly easy, though not without pitfalls. In contrast, the diagnosis of atypical AIH poses great challenges. There is confusion as to the definition of the disease entity and its boundaries in the diagnosis of overlap syndrome, drug-induced autoimmune hepatitis, and AIH with concomitant nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C. Centrilobular zonal necrosis is now included in the histological spectrum of AIH. However, the definition and the significance of AIH presenting with centrilobular zonal necrosis have not been examined extensively. In ~20% of AIH patients who are treated for the first time with standard therapy, remission is not achieved. The development of more effective and better tolerated novel therapies is an urgent need. In this review, we discuss the current challenges and the future prospects in relation to the diagnosis and treatment of AIH, which have been attracting considerable recent attention.

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“…Quite to the contrary, in recent years, it has become evident that AIH may coexist with various other liver diseases. While coexistence with viral hepatitis received most attention in the past decades, coexistence with NASH is now recognized as an increasingly common phenomenon presenting both diagnostic and therapeutic challenges …”

Section: Diagnosis Of Autoimmune Hepatitismentioning

confidence: 99%

“…Transaminases and IgG/gammaglobulins have been used in the past, but these biomarkers do not reflect AIH activity in all clinical settings. For example, transaminase levels could also be elevated in concomitant fatty liver disease . Some patients show normalized transaminases, but still elevated levels of IgG under treatment: it is currently unclear to what degree this finding reflects relevant tissue inflammatory activity and whether it requires intensification of immunosuppression.…”

Section: Treatment Of Autoimmune Hepatitismentioning

confidence: 99%

Autoimmune hepatitis: From current knowledge and clinical practice to future research agenda

Sebode

Hartl

Vergani

et al. 2017

Liver International

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Autoimmune hepatitis is a chronic inflammatory liver disease. Unknown triggers lead to a mainly T cell-mediated immune response targeting the liver, the main auto-antigen of which has not been identified yet. The diagnosis of autoimmune hepatitis is based on the elevation of immunoglobulin G/hypergammaglobulinemia, detection of characteristic autoantibodies as well as a typical pattern on liver histology. Exclusion of other causes of hepatitis and response to immunosuppressive treatment support the diagnosis of autoimmune hepatitis. The mainstay of autoimmune hepatitis treatment has, from its first description to the current time, consisted of predniso(lo)ne to induce remission, in combination with azathioprine, which is used to maintain it. Nonetheless, side effects and non-response with ongoing inflammation despite standard therapy demand treatment alternatives. Only through a better understanding of the pathogenesis of autoimmune hepatitis can a more selective and effective treatment be offered to patients in the future. Until this goal is reached, improvement of diagnostic approaches and optimization of current therapy rank highest on the research agenda for autoimmune hepatitis.

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Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease

Cited by 70 publications

References 21 publications

Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation

Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation

Autoimmune hepatitis: current challenges and future prospects

Autoimmune hepatitis: From current knowledge and clinical practice to future research agenda

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