Diagnosis and treatment of autoimmune hepatitis at age 65 and older

Verslype, Chris; George, Carolyn; Buchel, Elwin; Nevens, Frederik; Steenbergen, Werner Van; Fevery, Johan

doi:10.1111/j.1365-2036.2005.02403.x

Cited by 44 publications

(44 citation statements)

References 18 publications

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“…Human leukocyte antigen DR status has been reported to affect the clinical features of patients with autoimmune hepatitis (1). Thus, the clinical features of Japanese elderly patients may differ from those of previous reports (3)(4)(5)(6). Here, we evaluated the clinical features of Japanese elderly patients (!65 years) with type 1 autoimmune hepatitis com-pared to those of Japanese younger patients (<65 years).…”

Section: Autoimmune Hepatitis Is An Unresolving Inflammation Of the Lmentioning

confidence: 95%

“…Recent reports from the patients with a main susceptibility of human leukocyte antigen DR3 and DR4, however, reveal that peak occurrences are between ages 10 and 30 years and between 40 and 50 years, and elderly patients have higher frequencies of human leukocyte antigen DR4, concurrent autoimmune disease, and cirrhosis at presentation (3)(4)(5)(6).…”

Section: Autoimmune Hepatitis Is An Unresolving Inflammation Of the Lmentioning

confidence: 99%

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Clinical Features of Japanese Elderly Patients with Type 1 Autoimmune Hepatitis

et al. 2007

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0049), and higher frequencies of cirrhosis (F4) and pre-cirrhosis (F3) (p=0.014) compared with the younger patients. In contrast, in elderly patients, the cumulative incidental rate of the normalization of serum alanine aminotransferase levels within 6 months after the introduction of initial treatment was higher in those treatedwith prednisolone !20 mg/day than those treated only with ursodeoxycholic acid (p=0.001). ConclusionWe speculate that more years may pass between the occurrence of the disease and the presentation in Japanese elderly patients than in younger patients, and we considered that, even in elderly patients, those with advanced fibrosis should be treated with prednisolone in order to prevent progress of the disease into liver failure.

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Section: Autoimmune Hepatitis Is An Unresolving Inflammation Of the Lmentioning

confidence: 95%

Section: Autoimmune Hepatitis Is An Unresolving Inflammation Of the Lmentioning

confidence: 99%

Clinical Features of Japanese Elderly Patients with Type 1 Autoimmune Hepatitis

et al. 2007

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“…Inflammation causes cholestasis and the liver develops cirrhosis (9). AIH is treated with immunosuppressive drugs, such as prednisolone or azathioprine (10,11), while PBC is treated with ursodeoxycholic acid (10). It is important to differentiate AIH from PBC due to the differences in the clinical course and management of the two diseases.…”

Section: Introductionmentioning

confidence: 99%

Anti-mitochondrial M2 antibody-positive autoimmune hepatitis

Tomizawa

Shinozaki

Fugo

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Anti-mitochondrial M2 antibody (AMA-M2) is specific to primary biliary cirrhosis (PBC), but can also be found in certain patients with autoimmune hepatitis (AIH). Effective methods of differentiating between PBC and AIH are required, as their clinical course and management are different. Titers of AMA-M2 were analyzed before and after follow-up in patients with PBC or AIH. Patients who underwent liver biopsy and were diagnosed with either AIH (10 patients) or PBC (3 patients) were enrolled in the study. The AMA-M2 antibody titers of these patients were analyzed upon hospital admission. AMA-M2 reacted with the pyruvate dehydrogenase complex-E2, branched-chain 2-oxo acid dehydrogenase complex and 2-oxoglutaric acid dehydrogenase complex in the assay utilized for this study. The cut-off value for AMA-M2 was 5. Six AIH patients were AMA-M2(-) and 4 were AMA-M2(+). The titer for the AIH patients who were AMA-M2(+) was 24.8±14.8, compared with 324±174 in the patients with PBC (P= 0.0138). Three AMA-M2(+) AIH patients were followed-up after liver biopsy. The AMA-M2 levels had decreased in all 3 patients, becoming undetectable in 2 of them. In conclusion, certain patients with AIH in this study were found to be AMA-M2(+), but the titers were significantly lower than those in the patients with PBC. At follow-up, the AIH patients exhibited decreased AMA-M2 titers. IntroductionAutoimmune hepatitis (AIH) is caused by an immune attack on the hepatocytes (1). Patients with AIH are positive for auto-antibodies, such as anti-nuclear, anti-smooth muscle and liver-kidney microsomal type 1 antibodies (2). Chronic inflammation in the liver can progress to liver cirrhosis (3). One major problem of AIH is that an acute presentation or exacerbation of the disease can progress to liver failure (4,5). Furthermore, patients with AIH can be susceptible to hepatocellular carcinoma (6); therefore, patients should be followed-up for exacerbation and hepatocellular carcinoma (7). Primary biliary cirrhosis (PBC) is characterized by nonsuppurative cholangitis and autoimmune-mediated destruction of the small or medium-sized bile ducts (8). Inflammation causes cholestasis and the liver develops cirrhosis (9). AIH is treated with immunosuppressive drugs, such as prednisolone or azathioprine (10,11), while PBC is treated with ursodeoxycholic acid (10). It is important to differentiate AIH from PBC due to the differences in the clinical course and management of the two diseases.Anti-mitochondrial antibody (AMA) can be tested via indirect immunofluorescence (12). In this technique, unfixed sections of the kidney and stomach of Wistar rats are used. AMA is used for the diagnosis of PBC (13), as 90-95% of patients with PBC are positive for AMA (14); however, the use of AMA as a differential test is problematic, as 5% of patients with AIH are positive for AMA (15), and the interpretation of a positive AMA result in AIH is difficult.The auto-antigens of AMA have been identified as pyruvate dehydrogenase complex-E2 (PDC-E2), branched-chain 2-oxo...

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“…Vingt patients de notre série, soit 24 %, avaient un âge supérieur ou égal à 65 ans, ce qui rejoint les taux rapportés dans la littérature [4,5,6]. Malgré cette fréquence non négligeable, l'HAI est souvent sous-diagnostiquée chez le sujet âgé [7,8].…”

Section: Discussionunclassified

“…Il n'a, cependant, pas été distingué dans ces études s'il s'agissait d'une exacerbation d'une hépatite chronique préexistante d'évolution indolente ou d'une HAI de novo. Ces données n'ont, par ailleurs, pas été confirmées par les études plus récentes [5,8], ce qui doit amener à évoquer le diagnostic d'HAI quel que soit le mode de présentation de la maladie. Dans notre série rétrospective, 25 % des sujets de plus de 65 ans et 34,9 % des sujets plus jeunes avaient un tableau d'hépatite aiguë à leur admission.…”

Section: Discussionunclassified

Particularités de l’hépatite auto-immune chez le sujet âgé en Tunisie. Résultats d’une étude multicentrique

Debbech

Màamouri

Ajmi

et al. 2008

J Afr Hepato Gastroenterol

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L'hépatite auto-immune (HAI) est classiquement reconnue comme une maladie de la femme jeune. Les études récentes suggèrent que cette hépatopathie touche également de façon importante les différentes tranches d'âge et, en particulier, le sujet âgé chez qui elle est souvent sous-diagnostiquée.But : Étudier les caractéristiques cliniques, immunologiques, histologiques et évolutives de l'HAI chez les patients âgés et de les comparer à celles des adultes plus jeunes.Matériel et méthodes : Nous avons revu à travers une étude rétrospective, multicentrique tunisienne, les caractéristiques de 20 patients atteints d'HAI diagnostiquée à un âge supérieur ou égal à 65 ans, et nous les avons comparés à celles de 63 malades plus jeunes.Résultats : Les manifestations cliniques étaient identiques chez les sujets âgés en comparaison aux sujets plus jeunes, en dehors d'un pourcentage plus élevé du syndrome ascitique. La fréquence de la cirrhose et des varices oesophagiennes à l'admission était plus élevée chez les sujets d'âge supérieur ou égal à 65 ans. Cependant, aucune différence biologique, immunologique et histologique n'a été notée. La fréquence des manifestations auto-immunes était identique entre les deux groupes. Le taux de rémission complète sous traitement était également similaire chez les sujets âgés et plus jeunes.Conclusion : L'HAI est fréquente chez les sujets d'âge supérieur ou égal à 65 ans. Les patients âgés ont une fréquence plus élevée de cirrhose à l'admission que les patients plus jeunes. Le taux de rémission sous traitement et le taux de récidive sont identiques entre les deux groupes. L'HAI doit être évoquée chez tous les sujets âgés atteints d'une hépatopathie chronique. Le diagnostic doit faire instaurer un traitement conventionnel.Abstract: Autoimmune hepatitis is traditionally described as a disease affecting young women. Current studies indicate that the disease occurs commonly and significantly across all age ranges, and in the elderly in particular, where it is frequently underdiagnosed.

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Diagnosis and treatment of autoimmune hepatitis at age 65 and older

Cited by 44 publications

References 18 publications

Clinical Features of Japanese Elderly Patients with Type 1 Autoimmune Hepatitis

Clinical Features of Japanese Elderly Patients with Type 1 Autoimmune Hepatitis

Anti-mitochondrial M2 antibody-positive autoimmune hepatitis

Particularités de l’hépatite auto-immune chez le sujet âgé en Tunisie. Résultats d’une étude multicentrique

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