Autoimmune hepatitis in children: Progression of 20 cases in northern Mexico

Nares-Cisneros, Jesús; Jaramillo-Rodríguez, Yolanda

doi:10.1016/j.rgmxen.2014.11.002

Cited by 9 publications

(19 citation statements)

References 41 publications

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“…The diagnosis is based on abnormal cholangiogram in patients with AIH phenotype, irrespective of histological findings. Recently, the European Society of Pediatric Gastroenterology Hepatology and Nutrition Hepatology Committee proposed a diagnostic scoring system to differentiate between juvenile AIH and ASC …”

Section: Special Features Of Aih In South Americamentioning

confidence: 99%

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Particularities of Autoimmune Hepatitis in Latin America

Porta

Cançado

2020

Clin. Liver Dis.

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Section: Special Features Of Aih In South Americamentioning

confidence: 99%

“…The main clinical features are described in Tables and : differences of AIH and ASC prevalence, serological markers, response to classical treatment with predniso(lo)ne and azathioprine (Aza), and use of alternative therapy . Anti‐SLA/LP antibodies are rarely present in pediatric patients.…”

Section: Special Features Of Aih In South Americamentioning

confidence: 99%

Particularities of Autoimmune Hepatitis in Latin America

Porta

Cançado

2020

Clin. Liver Dis.

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“…До недавнего времени клинические проявления АИГ у детей в основном описывались у пациентов европейского происхождения [24,[27][28][29][30][31][32][33], причем это заболевание редко встречалось у людей из других этнических групп. Однако, исходя из недавних исследований, это утверждение оказалось неверным [33][34][35][36][37][38][39][40][41][42][43].…”

Section: клиническо-лабораторные проявления аутоиммунного гепатита у unclassified

“…Тяжесть заболевания аналогична при обоих типах АИГ. Тем не менее АИГ-2 имеет более высокую тенденцию к развитию острой печеночной недостаточности и является более рефрактерным к терапии [24,34,41].…”

Section: клиническо-лабораторные проявления аутоиммунного гепатита у unclassified

“…Как упоминалось выше, АИГ все чаще диагностируется у европейских детей и подростков, вероятно, потому что диагноз аутоиммунного заболевания печени пропускался из-за выявления вирусных гепатитов В и С. Исследования в группах от 5 до 181 (в среднем 34) пациентов, проводившиеся в Индии [35,42], Малайзии [39], Пакистане [38], Бахрейне [37], Иране [36], Египте [34], Ямайке [43], Мексике [41], -указывают на клинические проявления и ответ на иммуносупрессивную терапию, сходный с таковым у европейских пациентов, но в целом более худший ответ на лечение и исход заболевания, вероятно, был связан с поздней диагностикой и задержкой направления пациентов в специализированные центры.…”

Section: клиническо-лабораторные проявления аутоиммунного гепатита у unclassified

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Autoimmune Hepatitis in Children: The Current State of the Problem

Волынец

Хавкин

Skvortsova

et al. 2018

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim.To generalize the results of existing research studies carried out to investigate autoimmune hepatitis (AIH) in children, and the contemporary approaches to the diagnosis and therapy of the disease. Key points. According to the results of serological studies, two types of AIH can be distinguished in children. AIH of type 1 is diagnosed, when anti-smooth muscle autoantibodies (ASMA) and/or antinuclear autoantibodies (ANA) have been detected. AIH of type 2 AIH is diagnosed, when liver kidney microsomal autoantibodies (anti-LKM-1) and/ or anti-liver cytosolic autoantibodies (anti-LC-1) have been detected. Liver parenchymal inflammation responds well to a standard immunosuppressive therapy with prednisolone and azathioprine. Disease relapses are observed in about 40% of patients during treatment. It is expedient to treat children at least for 2–3 years before attempting to cancel the treatment, which decision should be considered only when the levels of transaminases have remained normal and IgG has been negative, or autoantibody titers have been low (1:20 using immunofluorescence method) for at least a year. Before attempting to cancel the therapy, liver biopsy and histological study should be repeated in order to exclude the possibility of residual inflammatory changes. For a small number of patients, who do not respond to standard treatment and those who suffer from frequent disease relapses, it is advisable to offer an alternative immunosuppressive treatment, the effectiveness of which is still ambiguous and poorly understood (including, in order of priority, mycophenolate mofetil, calcineurin inhibitors, rituximab, Inhibitor of tumor necrosis factor-alpha). In cases of refractoriness to therapy and the disease progression to liver cirrhosis and its decompensation, liver transplantation is justified. It is shown that AIH might relapse after liver transplantation. De novo AIH develops after liver transplantation as a result of non-autoimmune diseases; it is characterized by the presence of autoantibodies (ANA, ASMA and typical or atypical anti-LKM-1), and histologically characterized by a pattern similar to that of AIH. De novo AIH after liver transplantation responds well to a classical immunosuppressive therapy, but not to a standard antiretroviral therapy. In the review, we discuss issues associated with the clinical manifestations and diagnosis of AIH in children. Approaches to the treatment and long-term observation of such children are reviewed, including, i.e., those formulated by the main group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) members.Conclusion. Autoimmune hepatitis (AIH) in children has a progressive course with the outcome to liver cirrhosis. The presented review has summarized approaches to the diagnosis and selection of AIH therapy in children.

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Epidemiology and health care burden of autoimmune liver diseases in Mexico

Cessa-Zanatta,

Cortez-Hernández,

Goyes

et al. 2024

Clinical Liver Disease

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Autoimmune liver diseases (ALDs) are chronic inflammatory hepatobiliary disorders, including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis, and their overlap forms. These diseases are recognized as causes of chronic liver disease. [1] However, in Mexico, the epidemiological data regarding ALDs are limited, despite cirrhosis being the fourth leading cause of death among Mexican adults, making it one of the highest rates in Latin America. [2][3][4] The global impact of ALDs is significant, including high rates of morbidity, premature mortality, and economic burden. Recent research findings indicate that biopsy-confirmed cirrhosis was present in 34% of the 183 patients diagnosed with AIH. Notably, the study showed that Hispanics had the highest prevalence of cirrhosis, with a percentage as high as 55%. [5] Another study conducted in the United States examined hospitalizations with primary discharge diagnosis of AIH between 2008 and 2012. The results showed that the national rate of AIH hospitalizations was 0.73 hospitalizations per 100,000 population, with Latinos being hospitalized for AIH at a rate 20% higher than that Whites (p < 0.001). [6] Given the increasing prevalence and impact of ALDs, population-based studies are crucial to better understand the epidemiology and future trends of these conditions in Mexico. Therefore, our study aims to address this gap by addressing the epidemiology of ALD in the Mexican population.Access to autoantibody testing, along with better imaging studies like transient elastography and advanced clinical programs, may impact the timely diagnosis and management of ALDs. This statement is supported by data from the Global PBC Study Group, which reports that the proportion of patients with early-stage PBC has increased from 41% in the 1970s to 72% in the 1990s. This increase could be explained by earlier detection of PBC due to more liver function tests and antimitochondrial antibodies assays being done in the general population. [7] In Mexico, 77% of patients with cirrhosis are diagnosed after a first episode of decompensation, with a mean Child-Pugh score of seven. Regarding ALDs literature, it is proposed that AIH in non-White patients may present more frequently with advanced disease at initial diagnosis. Wong et al [5] described that 45% of Hispanic patients present with cirrhosis at initial diagnosis, while Muñoz-Espinosa et al [8] published that cirrhosis was present at diagnosis of 56% of Mexican patients with AIH. These findings highlight the importance of implementing accessible screening programs to identify patients before they have advanced disease. [9,10] Previous studies have suggested an increasing trend of ALDs among Mexican women. For instance, a retrospective study conducted in 2016, which included 785 liver biopsies, reported a prevalence of 8.

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Autoimmune hepatitis in children: Progression of 20 cases in northern Mexico

Cited by 9 publications

References 41 publications

Particularities of Autoimmune Hepatitis in Latin America

Particularities of Autoimmune Hepatitis in Latin America

Autoimmune Hepatitis in Children: The Current State of the Problem

Epidemiology and health care burden of autoimmune liver diseases in Mexico

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