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

Weiler‐Normann, Christina; Lohse, Ansgar W.

doi:10.1007/s10620-016-4258-3

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…On the other hand, ANA is one of the characteristic parameters in AIH. Liver biopsy is required to rule out AIH in most NAFLD patients with positive ANA because AIH scoring system was found to be insufficient without liver biopsy in adults (11,13,14,16). In different studies, 0.5-8% of NAFLD patients with positive autoantibodies was diagnosed with definite AIH after liver biopsy (9,10).…”

Section: Resultsmentioning

confidence: 99%

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları

Kırşaçlıoğlu¹,

Sanrı²,

Hızal³

et al. 2019

Turkish Journal of Pediatric Disease

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Objective:The prevalence of non-alcoholic fatty liver disease (NAFLD) in children increased parallel to the increment of childhood obesity. Also, NAFLD may be the presenting feature of different liver diseases in non-obese children. We aimed to determine whether there were co-existing liver diseases in overweight and obese children with NAFLD. Material and Methods:Pediatric gastroenterology outpatient clinic records of obese and overweight patients, aged between 5-18 years, were retrospectively reviewed. Seventy patients who had liver steatosis on ultrasonography, and alanine aminotransferase (ALT) levels were higher than 1.5 times the upper limit of normal were recruited to the study. The demographic findings, laboratory tests for infectious, metabolic, and autoimmune causes, abdominal ultrasonography and liver biopsy findings of patients were recorded.Results: At presentation, 94.2% of the patients (n: 66) had mild transaminase elevation. All patients were negative for viral hepatitis, anti-tissue transglutaminase immunoglobulin (Ig) A, anti-liver-kidney-microsome type 1 and anti-smooth muscle antibody. They had normal erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ceruloplasmin, and total IgG levels. Only one patient with low alpha-1 antitrypsin levels had heterozygotes of the PiMZ phenotype. Three (4.3%) patients had antinuclear antibody (ANA) positivity. 44.7% of patients were given ursodeoxycholic acid treatment. On follow-up, normalization of ALT was achieved in 31 (44.2%) patients at mean 6.1±4.6 (2-19) months, but no relation was found between normalization and ursodeoxycholic acid treatment. A patient with ANA positivity had increased ALT, ESR, CRP, IgG levels and ANA titers on follow-up, and she was diagnosed with autoimmune hepatitis with the support of liver biopsy. Under prednisolone and azathioprine treatment, ESR and IgG levels were normalized, ALT and ANA titers decreased. Conclusion:Other causes of chronic hepatitis should be screened in obesity-related non-alcoholic fatty liver disease and the development of autoimmune hepatitis should be kept in mind in the presence of ANA. ÖZAmaç: Çocuklarda obezitede artışa parallel olarak alkolik olmayan yağlı karaciğer hastalığı (AOYKH) da giderek artmaktadır. Ancak obez olmayan çocuklarda, farklı karaciğer hastalıklarında da karaciğer yağlanması görülebilir. Bu çalışmada aşırı kilolu ve obez çocuklarda, AOYKH'ye eşlik edebilecek diğer karaciğer hastalıklarının belirlenmesi amaçlandı. Gereç ve Yöntemler:Polikliniğimizde aşırı kilo ya da obezite ile izlenen, 5-18 yaş aralığındaki hastaların dosyaları geriye dönük tarandı. Ultrasonografide karaciğerde yağlanma ve normalin üst sınırından en az 1.5 kat kadar alanin transaminaz (ALT) yüksekliği olan 70 hasta çalışmaya alındı. Hastaların demografik verileri, enfeksiyöz, metabolik ve otoimmun nedenler için yapılan laboratuvar testleri, abdominal ultrasonografi ve karaciğer biyopsi bulguları kaydedildi.Bulgular: Tanıda olguların %94.2'ünde (66 olgu) hafif transaminaz yüksekliği vardı. Tanıda viral...

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Section: Resultsmentioning

confidence: 99%

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları

Kırşaçlıoğlu¹,

Sanrı²,

Hızal³

et al. 2019

Turkish Journal of Pediatric Disease

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“…So far, there is only one small retrospective study indicating that patients with concurrent AIH and NASH (but not simple steatosis) are more likely to present with advanced disease associated with adverse clinical outcomes and decreased survival [220]. Therefore, NAFLD/NASH in this setting should be treated strictly and intensely according to current recommendations [216,217], while efforts should be made to use the lowest effective dose of steroids [221].…”

Section: Non Liver-related Comorbidities and Agingmentioning

confidence: 99%

Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis

Dalekos¹,

Koskinas

Papatheodoridis

2018

aog

152

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Autoimmune hepatitis (AIH) is a relatively rare acute or chronic liver disease of unknown etiology characterized by large heterogeneity. Its distribution is global, covering all ages, both sexes and all ethnic groups. The aim of the present Clinical Practice Guidelines (CPG) of the Hellenic Association for the Study of the Liver was to provide updated guidance and help to gastroenterologists, hepatologists, internists and general practitioners for AIH diagnosis and management. AIH diagnosis is based on clinicopathological characteristics: namely, polyclonal hypergammaglobulinemia, particularly of immunoglobulin G (IgG), circulating autoantibodies, interface hepatitis on liver histology, absence of viral hepatitis, and a favorable response to immunosuppression. Clinical manifestations at disease onset are variable, ranging from asymptomatic to the acute/severe form. Aminotransferase and bilirubin levels vary, while the presence of hepatitis at the histological level is a prerequisite for diagnosis. Autoantibodies are the hallmark for AIH diagnosis; therefore, the CPG describe the appropriate serological algorithm for their detection. AIH therapy should aim to achieve complete biochemical (normalization of IgG and aminotransferases) and histological remission. All patients who have active disease, even those with cirrhosis, should be treated with individualized and response-guided induction therapy using prednisolone in combination with azathioprine or mycophenolate mofetil as first-line therapy. Immunosuppression should be given for at least 3 years and for at least 2 years after the achievement of complete biochemical response, while a liver biopsy should be recommended before treatment discontinuation. Current CPG are also provided for several specific conditions and difficult-to-treat patients.

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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%

“…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. 21,22 Antibody testing for AIH is in imminent need of international standardization, as this is the basis of all diagnostic criteria, and false positive and false negative tests may occur. Though indirect immunofluorescence on rodent tissue sections is strongly recommended as a standard method, 23 ELISA and immunoblot tests also need standardization.…”

Section: Diagnosis Of Autoimmune Hepatitismentioning

confidence: 99%

See 1 more Smart Citation

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

Cited by 10 publications

References 8 publications

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları

Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis

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

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