Autoimmune hepatitis natural history, complications and prognosis
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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 is acquired usually has a bimodal age distribution, with the first peak of incidence at age 10-20 years and a second at age 45-70 years of life, Patient presents asymptomatically progresses 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 bad 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.