Patients With Typical Laboratory Features of Autoimmune Hepatitis Rarely Need a Liver Biopsy for Diagnosis

Bjõrnsson, Einar; Talwalkar, Jayant A.; Treeprasertsuk, Sombat; Neuhauser, Matthias; Lindor, Keith D.

doi:10.1016/j.cgh.2010.07.016

Cited by 55 publications

(48 citation statements)

References 25 publications

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“…The necessity of a liver biopsy for the diagnosis of AIH has been challenged [80]. The similarity of laboratory findings in AIH patients with either atypical histology (5%) or compatible histology (95%) led to the conclusion that AIH can be diagnosed accurately without a biopsy.…”

Section: Histopathology and The Role Of Liver Biopsy In Diagnosismentioning

confidence: 98%

Autoimmune hepatitis

Sahebjam

Vierling

2015

Front. Med.

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Autoimmune hepatitis is a chronic liver disease putatively caused by loss of tolerance to hepatocyte-specific autoantigens. It is characterized by female predilection, elevated aminotransferase levels, autoantibodies, increased γ-globulin or IgG levels and biopsy evidence of interface hepatitis. It is currently divided into types 1 and 2, based on expression of autoantibodies. Autoantigenic epitopes have been identified only for the less frequent type 2. Although autoimmune hepatitis occurs in childhood, this review focuses on disease in adults. In the absence of pathognomonic biomarkers, diagnosis requires consideration of clinical, biochemical, serological and histological features, which have been codified into validated diagnostic scoring systems. Since many features also occur in other chronic liver diseases, these scoring systems aid evaluation of the differential diagnosis. New practice guidelines have redefined criteria for remission to include complete biochemical and histological normalization on immunosuppressive therapy. Immunosuppression is most often successful using prednisone or prednisolone and azathioprine; however, the combination of budesonide and azathioprine for non-cirrhotic patients offers distinct advantages. Patients failing standard immunosuppression are candidates for alternative immunosuppressive regimens, yet none of the options has been studied in a randomized, controlled trial. Overlap syndromes with either primary sclerosing cholangitis or primary biliary cirrhosis occur in a minority. Liver transplantation represents a life-saving option for patients presenting with acute liver failure, severely decompensated cirrhosis or hepatocellular carcinoma. Transplant recipients are at risk for recurrent autoimmune hepatitis in the allograft, and de novo disease may occur in patients transplanted for other indications. Patients transplanted for AIH are also at risk for recurrent or de novo inflammatory bowel disease. Progress in our understanding of the immunopathogenesis should lead to identification of specific diagnostic and prognostic biomarkers and new therapeutic strategies.

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Section: Histopathology and The Role Of Liver Biopsy In Diagnosismentioning

confidence: 98%

Autoimmune hepatitis

Sahebjam

Vierling

2015

Front. Med.

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“…40 A small number of patients in our study did not have a liver biopsy performed, presumably due to coagulopathy; however, these patients had clinical and biochemical features of AIH, were treated as such, and exhibited good response. In a study in adults, Björnsson et al 41 concluded that liver biopsies are not needed in most cases when patients have typical features of AIH. This conclusion could have some applicability in the pediatric population.…”

Section: Figurementioning

confidence: 99%

Incidence and Characteristics of Autoimmune Hepatitis

et al. 2015

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“…Unfortunately, diagnosis of cirrhosis may not be confirmed by liver biopsy in up to 40% of cases [1,11] due to sampling variability. Small sample size of around 1/50,000 of total liver parenchyma indicates that needle biopsy material may be obtained from a large parenchymal nodule, thus lacking the characteristic fibrous septa and nodular configuration and making histological diagnosis of cirrhosis very difficult.…”

Section: Aih Presenting With Cirrhosismentioning

confidence: 99%

“…Thus, patients with a clinically based diagnosis of probable AIH may not differ from those where AIH was confirmed or supported by liver biopsy [10] . A recent study has questioned the value of liver biopsy in patients with typical laboratory features of AIH, since liver histology did not show any additional or unexpected findings that could affect patient management in the vast majority of cases [11] . However, the significance of liver biopsy in dismissing the diagnosis in patients who otherwise would have been misclassified without a tissue examination was not addressed in this study [12] .…”

Section: Contribution Of Histology In the Diagnostic Scoring Systems mentioning

confidence: 99%

Role of Histopathology in Autoimmune Hepatitis

Tiniakos

Brain

Bury

2015

Dig Dis

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The diagnosis of autoimmune hepatitis (AIH) is based on a combination of biochemical, immunological and histological features and exclusion of other causes of liver disease. Typical histological features include a chronic hepatitis pattern of injury with portal inflammation and interface activity, predominance of plasma cells in the portal infiltrate, emperipolesis, and hepatocellular rosette formation. Centrilobular injury with prominent hepatocellular necrosis and mononuclear inflammation is now recognised in the histological spectrum of AIH and may represent an early stage of the disease. Liver histology plays a major role in clinical diagnostic scoring systems and is important to confirm or support the clinical diagnosis of AIH. This review focuses on the role of histopathology in AIH and highlights the contribution of histological interpretation to the diagnosis of AIH, differential diagnosis from other entities, recognition of concurrent liver disease, and identification of the so-called overlap or variant syndromes, and addresses the importance of liver biopsy in the management and prognosis of patients with AIH.

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Patients With Typical Laboratory Features of Autoimmune Hepatitis Rarely Need a Liver Biopsy for Diagnosis

Cited by 55 publications

References 25 publications

Autoimmune hepatitis

Autoimmune hepatitis

Incidence and Characteristics of Autoimmune Hepatitis

Role of Histopathology in Autoimmune Hepatitis

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