Increasing incidence of elderly‐onset autoimmune hepatitis

Morii, Kazuhiko; Nagano, Yuh; Yamamoto, Tetsuya; Nakamura, Shinichiro; Okushin, Hiroaki

doi:10.1111/ggi.12874

Cited by 12 publications

(16 citation statements)

References 33 publications

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“…This is contrary to the classical description that AIH mainly affects young and middle‐aged women . However, several recent published studies reveal an increasing incidence/prevalence rate of AIH in elder women, and this could not be explained by delay in diagnosis or age distribution in study population . Thus, more attention should be paid on elder patients.…”

Section: Discussioncontrasting

confidence: 75%

Systematic review and meta‐analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population

Zeng

et al. 2019

J of Gastro and Hepatol

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Background and Aim Reported incidence and prevalence rates of autoimmune hepatitis (AIH) have been sparse and heterogeneous. The aim of this meta‐analysis was to estimate the worldwide incidence and prevalence rates of AIH and reveal population difference. Methods Published articles on the epidemiology of AIH in PubMed, Embase, and Cochrane Library were systematically searched from inception to April 28, 2019. Two investigators independently reviewed these literatures and evaluated their quality. A random‐effects model was used to pool the overall incidence and prevalence rates. The impact of population difference, gender, age, study period, study quality, diagnostic criteria, and study design was further analyzed with subgroup analysis and meta‐regression. Results A total of 22 studies were included in the meta‐analysis. The pooled worldwide annual incidence and prevalence of AIH were 1.37 (95% confidence interval [CI]: 0.95–1.80) and 17.44 (95% CI: 12.01–22.87) per 100 000 persons, respectively. Subgroup analysis showed that the pooled annual incidence for Asian, European, and American population was 1.31 (95% CI: 0.42–2.20), 1.37 (95% CI: 1.10–1.64), and 1.00 (95% CI: 0.44–1.56) per 100 000 persons, respectively; the pooled prevalence for Asian, European, and American population was 12.99 (95% CI: 2.05–23.92), 19.44 (95% CI: 15.63–23.24), and 22.80 (95% CI: −13.48 to 59.07) per 100 000 persons, respectively. In addition, higher incidence and prevalence rates were observed in women than men, and a higher prevalence rate was observed in elderly than young people. Conclusions Autoimmune hepatitis is a rare disease, with a similar incidence worldwide and a higher prevalence in European and American than in Asian population.

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Section: Discussioncontrasting

confidence: 75%

Systematic review and meta‐analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population

Zeng

et al. 2019

J of Gastro and Hepatol

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“…Characteristics of the seven included studies are summarised in Table 2[6,9,20-24]. They were comparative cohort studies, which were performed in seven different countries (North America, Europe and Asia) and published between 2001 and 2017.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical presentation was heterogeneous with both acute and chronic onset. Among AIH patients, 239 subjects (203 F, 36 M) were elders (≥ 60 years of age)[6,9,20-24]. Because different age threshold (≥ 60, ≥ 65, ≥ 70) were used to define elderly patients in the seven studies, the age range also differ in the comparator group.…”

Section: Resultsmentioning

confidence: 99%

“…Studies differed for types of treatments and drug dosages (Table 3). However, in all studies except one, elderly patients were treated with a steroid either alone or in combination with AZA (170 out of 194 patients)[6,9,21-24]. The study by Zachou et al[20] assessed the performance of an alternative first-line treatment with prednisolone and MMF.…”

Section: Resultsmentioning

confidence: 99%

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Autoimmune hepatitis treatment in the elderly: A systematic review

Durazzo

Lupi

Scandella

et al. 2019

WJG

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BACKGROUND Autoimmune hepatitis (AIH) is a rare chronic inflammatory liver disease with a high risk of progression to liver cirrhosis. The initial treatment for AIH usually includes a steroid, with or without azathioprine. AIH can present at any age; however, the most effective and safe induction treatment for AIH in the elderly remains unclear. AIM To systematically review available data on both effectiveness and safety of AIH treatments in elderly subjects. METHODS To identify studies on AIH induction treatment in elderly patients (≥ 60 years of age), an electronic research was performed (PubMed, EMBASE and Cochrane Library databases) until February 2019. Eligible studies were selected through screening of titles and abstracts, followed by full-text critical evaluation. After risk of bias assessment, data on study designs, interventions, and outcomes were extracted and reviewed. RESULTS Among the 1736 retrieved papers, 15 studies were selected. Out of them, eight studies were excluded because of a critical risk of bias. The remaining seven studies included 789 patients and out of them 239 subjects were elders. First-line treatment was a steroid either alone or in combination with azathioprine in most patients (87.6%) and only one study investigated the effect of combined steroid and mycophenolate mofetil therapy. Standard therapy was effective in inducing remission in the elderly. Moreover, treatment failure and relapses occurred less often in the elderly compared to younger people. CONCLUSION Treatment of AIH is challenging in elderly patients. This systematic review confirms the efficacy and safety of standard induction treatment for AIH in the elderly. Available evidence is insufficient to draw any conclusion on the effect of novel AIH treatments in elderly subjects.

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“…Improvements in imaging technologies, the aging of our society and sociogeographical differences (food, climates, environment, economic situation and prevailing pathogens) may affect the incidence of IHC. For example, as people grow older, existent hepatic cysts tend to increase in size, and the host immunity may deteriorate, thereby increasing the probability of developing an IHC (4,27). Physicians should be aware that the IHCs may be more frequent than previously regarded (28).…”

Section: Discussionmentioning

confidence: 99%

Infectious Hepatic Cyst: An Underestimated Complication

et al. 2018

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Objective An infectious hepatic cyst (IHC) is a hepatic cyst complicated with secondary infection and is generally assumed to be rare. However, we have experienced no small number of patients with IHC in recent clinical practice. We therefore examined the incidence and clinical characteristics of IHC. Methods The medical records of patients with IHC who were hospitalized at our institution between January 2012 and December 2016 were retrospectively reviewed. Their demographic factors, biochemical, bacteriological, imaging, and treatment results were explored and compared with those of patients with pyogenic liver abscess (PLA). Patients Twelve patients with IHC and 39 with PLA were identified. Results The IHCs were significantly larger in diameters than the PLAs, and patients with IHCs tended to be older and more often women than those with PLAs. IHCs showed characteristic imaging features, including heterogeneous contents with occasional fluid-debris levels, a thickened cystic wall with rim enhancement, perilesional edema and hyperaemia. Patients with IHCs had a significantly shorter hospital stay than those with PLAs. Conclusion Physicians should note that IHCs are not rare. A careful imaging evaluation can suggest an IHC, and the timely aspiration of the content can lead to an accurate diagnosis. The cystic wall may keep the infectious material confined within the IHC, resulting in the observed good treatment outcome with catheter drainage.

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Increasing incidence of elderly‐onset autoimmune hepatitis

Cited by 12 publications

References 33 publications

Systematic review and meta‐analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population

Systematic review and meta‐analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population

Autoimmune hepatitis treatment in the elderly: A systematic review

Infectious Hepatic Cyst: An Underestimated Complication

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