Pregnancy induces a state of immune tolerance with improvement of the liver tests in AIH. This could result from a transition of TH1 to TH2 predominance during pregnancy. A flare-up often occurs after delivery. Preemptive increase of the immunosuppressive therapy is therefore advocated consecutive to delivery. Azathioprine use seems to be safe during pregnancy.
Summary
Aim: To study features in older patients with autoimmune hepatitis, as this was considered mainly a disease of young females.
Methods: Analysis of 28 patients diagnosed at age ≥65 years compared with 84 younger patients.
Results: The incidence was similar at all age decades. The ratio M:F was 1 : 3 (≥65 years) vs. 1 : 2 (<65 years). Presenting symptoms were not different when compared with younger patients and consisted of general malaise and fatigue (36%), jaundice ± other symptoms (50%), or ascites (11%). Antinuclear antibodies (ANA) ≥ 1/80 were positive in 93%, smooth muscle antibodies (SMA) > 1/40 in 50%, anti‐liver kidney microsomes (anti‐LKM) proved always negative. Histology showed acute necrotizing hepatitis in 19%, severe interphase hepatitis in 15%, chronic hepatitis with plasmo‐lymphocytic infiltrate in 30%, cirrhosis in 29% (with active inflammation in one‐third); biopsy was refused in 11%. The elderly responded very well to low doses of methylprednisolone (≤8 mg) and azathioprine (1 mg/kg). This schedule obviates side‐effects such as infections seen with higher dosages.
Conclusion: Autoimmune hepatitis has to be also looked for in the elderly with acute and chronic hepatitis. The steroid therapy should be individualized but kept at a low dose.
Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.
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