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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Autoimmune hepatitis presents with asymptomatic abnormalities of liver tests, jaundice, acute hepatitis that fails to resolve, arthralgia or the complications of liver disease. Other autoimmune diseases may be present or develop, including thyroid disease, fibrosing alveolitis and glomerulonephritis. Examination reveals multiple spider naevi.
Non-viral liver disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
John ML Christie, Roger WG Chapman
Autoimmune hepatitis can be defined as a self-perpetuating hepatic inflammation characterized by interface hepatitis on histological examination, hypergammaglobulinaemia and liver-associated autoantibodies in the serum.62 The cause is unknown. The diagnosis requires exclusion of other causes of chronic liver disease that can give similar features, such as chronic viral infection, Wilson’s disease, alpha1 antitrypsin deficiency, haemochromatosis, non-alcoholic steatosis, and the immune cholangiopathies of primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune cholangitis. Recently, criteria for diagnosis have been coded and a quantitative scoring system exists to predict definite or probable diagnosis (Table 12.1).63
Hepatitis A Virus
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Progression to autoimmune hepatitis. Occasional patients who are recovering from HAV infection have been reported to develop autoimmune hepatitis type I. This occurrence possibly depends on an individual's prior susceptibility to autoimmune hepatitis, with HAV infection merely serving as a precipitant.
Soluble PD1 levels are increased with disease activity in paediatric onset autoimmune hepatitis and inflammatory bowel disease
Published in Autoimmunity, 2020
Timothy Hadley, Scott Gillespie, Hillary Espinoza, Jarod Prince, Henning Gronbaek, Shanmuganathan Chandrakasan, Subra Kuguthasan, Vasantha L. Kolachala, Nitika A. Gupta
Autoimmune hepatitis is an immune mediated chronic liver disease characterised by elevation in IgG, ALT, seropositivity for anti-smooth muscle, and anti LKM antibodies and presence of plasma cells and interface hepatitis on liver biopsy [11,12]. The understanding of what triggers the autoimmune inflammatory response continues to remain debateable, but it is suggested that a genetic disposition and molecular mimicry among others leads to a defective immune regulation. [1]. T cells play a major role in the inflammatory response in AIH [13] and defective T cell mediated immune regulation is regarded pivotal in the development of AIH [1,2,13,14]. in this study active AIH group demonstrated significantly higher levels of serum sPD1. Interestingly, when these patients responded to immunosuppressants, the sPD1 levels decreased which suggests decreased shedding of PD1 into plasma. Similar findings were shown by Aarslev et al. [14] in adult patients with AIH where sPD1 levels corresponded to response to therapy.
Clinicopathological impact of anti-smooth muscle antibodies in patients with non-alcoholic fatty liver disease
Published in British Journal of Biomedical Science, 2019
H Elalfy, MA El-Maksoud, S Abed, MA El Aziz, AZ Elsamanoudy, S M Abo El-khair, MA Mohamed, W Elkashef, K Zalata, R Farag, M Arafa
The problematic diagnosis of autoimmune hepatitis superimposed on NAFLD patients requires a higher titer of autoantibodies (ANA and/or ASMAbs) >1:40 to minimize the potential for false positive. The presence of autoimmune hepatitis-related autoantibodies supports the diagnosis of autoimmune hepatitis. Antibody titers >1:40 have a higher specificity for autoimmune hepatitis [15], whilst ANA and/or ASMAbs are considered requisites for the diagnosis of autoimmune hepatitis. We recognise the limitations that our study is restricted to one centre, and that our sample size is not large. Thus, these findings need confirmation from other centres and in larger prospective studies for their generalizability. Our work represents an advance in biomedical science because it demonstrates that ASMAbs are frequently present among patients with NAFLD and are linked to liver fibrosis and other scores of liver disease.
Systematic review with meta-analysis: autoimmune hepatitis in pregnancy
Published in Scandinavian Journal of Gastroenterology, 2021
Hydar El Jamaly, Guy D. Eslick, Martin Weltman
Autoimmune hepatitis is an uncommon progressive chronic inflammatory disease of the liver, typically characterised by elevated autoantibodies, hypergammaglobulinemia and histologically of inflammatory cell infiltrate and interface hepatitis [1]. The disease predominantly affects females of all ages. A variety of clinical presentations may be observed ranging from mild, almost subclinical disease to fulminant hepatitis. AIH poses the risk of complications such as cirrhosis, acute liver failure requiring urgent liver transplantation and death. Its hallmark distinguishing feature amongst autoimmune liver diseases is the response to corticosteroids. Prognosis is significantly improved with first line immunosuppressive therapy with most cases (90%) surviving ten years [2].