Autoimmune hepatitis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Autoimmune hepatitis has a bimodal age distribution, with the first peak of incidence at age 10-20 years and a second at age 45-70 years. Patients presents initially with no symptom but can progress to [[acute liver failure]] If not treated, patients can develop [[complications]] like [[cirrhosis]], [[portal hypertension]], [[esophageal varices]], metabolic [[bone disease]], [[hyperlipidemia|hyperlipidaemia]], hypovitaminosis, [[cholestasis]]. Prognosis is generally excellent, and the 10-year survival rate of patients with autoimmune hepatitis treated with [[Immunosuppression|immunosuppressive]] therapy is approximately 80%. The presence of young age at presentation, AIH-2, [[coagulopathy]], severe [[histologic]] activity is associated with a poor prognosis among patients with autoimmune hepatitis. | |||
==Natural History | ==Natural History== | ||
*The symptoms of | *The symptoms of [[autoimmune hepatitis]] usually has a bimodal age distribution, with a first peak of incidence at age 10-20 years and a second at age 45-70 years of life, and starts with asymptomatic progresses to [[acute liver failure]].<ref name="pmid28272079">{{cite journal |vauthors=Sonthalia N, Rathi PM, Jain SS, Surude RG, Mohite AR, Pawar SV, Contractor Q |title=Natural History and Treatment Outcomes of Severe Autoimmune Hepatitis |journal=J. Clin. Gastroenterol. |volume=51 |issue=6 |pages=548–556 |year=2017 |pmid=28272079 |doi=10.1097/MCG.0000000000000805 |url=}}</ref> | ||
*If left untreated, patients with [[autoimmune hepatitis]] may progress to develop [[cirrhosis]], and [[portal hypertension]]. | |||
*If left untreated, | |||
===Complications=== | ===Complications=== | ||
Common complications of Autoimmune hepatitis include:<ref name="pmid23634279">{{cite journal |vauthors=Trivedi PJ, Hirschfield GM |title=Treatment of autoimmune liver disease: current and future therapeutic options |journal=Ther Adv Chronic Dis |volume=4 |issue=3 |pages=119–41 |year=2013 |pmid=23634279 |pmc=3629750 |doi=10.1177/2040622313478646 |url=}}</ref> | Common complications of [[Autoimmune hepatitis]] include:<ref name="pmid23634279">{{cite journal |vauthors=Trivedi PJ, Hirschfield GM |title=Treatment of autoimmune liver disease: current and future therapeutic options |journal=Ther Adv Chronic Dis |volume=4 |issue=3 |pages=119–41 |year=2013 |pmid=23634279 |pmc=3629750 |doi=10.1177/2040622313478646 |url=}}</ref><ref name="pmid21757447">{{cite journal |vauthors=Gleeson D, Heneghan MA |title=British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis |journal=Gut |volume=60 |issue=12 |pages=1611–29 |year=2011 |pmid=21757447 |doi=10.1136/gut.2010.235259 |url=}}</ref> | ||
*Cirrhosis and complications of cirrhosis | *[[Cirrhosis]] and complications of [[cirrhosis]]: | ||
**Ascites | **[[Ascites]] | ||
**Coagulopathy | **[[Coagulopathy]] | ||
**Liver failure | **[[Liver failure]] | ||
**Hepatocellular carcinoma | **[[Hepatocellular carcinoma]] | ||
**Hepatic encephalopathy | **[[Hepatic encephalopathy]] | ||
*Portal hypertension | *[[Portal hypertension]] | ||
*Esophageal varices | *[[Esophageal varices]] | ||
*Metabolic bone disease | *Metabolic [[bone disease]] | ||
*Hyperlipidaemia | *[[Hyperlipidemia|Hyperlipidaemia]] | ||
*Hypovitaminosis | *Hypovitaminosis | ||
* | *[[Cholestasis]] | ||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally excellent, and the 10-year survival rate of patients with | *Prognosis is generally excellent, and the 10-year survival rate of patients with [[autoimmune hepatitis]] treated with [[immunosuppressive]] therapy is approximately 80%.<ref name="pmid21396370">{{cite journal |vauthors=Hoeroldt B, McFarlane E, Dube A, Basumani P, Karajeh M, Campbell MJ, Gleeson D |title=Long-term outcomes of patients with autoimmune hepatitis managed at a nontransplant center |journal=Gastroenterology |volume=140 |issue=7 |pages=1980–9 |year=2011 |pmid=21396370 |doi=10.1053/j.gastro.2011.02.065 |url=}}</ref><ref name="pmid16298014">{{cite journal |vauthors=D'Amico G, Garcia-Tsao G, Pagliaro L |title=Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies |journal=J. Hepatol. |volume=44 |issue=1 |pages=217–31 |year=2006 |pmid=16298014 |doi=10.1016/j.jhep.2005.10.013 |url=}}</ref> | ||
*Prognosis is poor without treatment, 50% of patients with severe [[autoimmune hepatitis]] will die in a 5 years. | |||
*The presence of [ | *The presence of young age at presentation, AIH-2, [[coagulopathy]], severe [[histologic]] activity is associated with a poor prognosis among patients with [[autoimmune hepatitis]]. | ||
==References== | ==References== | ||
Latest revision as of 17:24, 9 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: :Manpreet Kaur, MD [2]
Overview
Autoimmune hepatitis has a bimodal age distribution, with the first peak of incidence at age 10-20 years and a second at age 45-70 years. Patients presents initially with no symptom but can progress to acute liver failure If not treated, patients can develop complications like cirrhosis, portal hypertension, esophageal varices, metabolic bone disease, hyperlipidaemia, hypovitaminosis, cholestasis. Prognosis is generally excellent, and the 10-year survival rate of patients with autoimmune hepatitis treated with immunosuppressive therapy is approximately 80%. The presence of young age at presentation, AIH-2, coagulopathy, severe histologic activity is associated with a poor prognosis among patients with autoimmune hepatitis.
Natural History
- The symptoms of autoimmune hepatitis usually has a bimodal age distribution, with a first peak of incidence at age 10-20 years and a second at age 45-70 years of life, and starts with asymptomatic progresses to acute liver failure.[1]
- If left untreated, patients with autoimmune hepatitis may progress to develop cirrhosis, and portal hypertension.
Complications
Common complications of Autoimmune hepatitis include:[2][3]
- Cirrhosis and complications of cirrhosis:
- Portal hypertension
- Esophageal varices
- Metabolic bone disease
- Hyperlipidaemia
- Hypovitaminosis
- Cholestasis
Prognosis
- Prognosis is generally excellent, and the 10-year survival rate of patients with autoimmune hepatitis treated with immunosuppressive therapy is approximately 80%.[4][5]
- Prognosis is poor without treatment, 50% of patients with severe autoimmune hepatitis will die in a 5 years.
- The presence of young age at presentation, AIH-2, coagulopathy, severe histologic activity is associated with a poor prognosis among patients with autoimmune hepatitis.
References
- ↑ Sonthalia N, Rathi PM, Jain SS, Surude RG, Mohite AR, Pawar SV, Contractor Q (2017). "Natural History and Treatment Outcomes of Severe Autoimmune Hepatitis". J. Clin. Gastroenterol. 51 (6): 548–556. doi:10.1097/MCG.0000000000000805. PMID 28272079.
- ↑ Trivedi PJ, Hirschfield GM (2013). "Treatment of autoimmune liver disease: current and future therapeutic options". Ther Adv Chronic Dis. 4 (3): 119–41. doi:10.1177/2040622313478646. PMC 3629750. PMID 23634279.
- ↑ Gleeson D, Heneghan MA (2011). "British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis". Gut. 60 (12): 1611–29. doi:10.1136/gut.2010.235259. PMID 21757447.
- ↑ Hoeroldt B, McFarlane E, Dube A, Basumani P, Karajeh M, Campbell MJ, Gleeson D (2011). "Long-term outcomes of patients with autoimmune hepatitis managed at a nontransplant center". Gastroenterology. 140 (7): 1980–9. doi:10.1053/j.gastro.2011.02.065. PMID 21396370.
- ↑ D'Amico G, Garcia-Tsao G, Pagliaro L (2006). "Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies". J. Hepatol. 44 (1): 217–31. doi:10.1016/j.jhep.2005.10.013. PMID 16298014.