Alcoholic liver disease and autoimmune hepatitis: Sometimes a closer look under the surface is needed
| Autor: | George N. Dalekos, Eirini I. Rigopoulou, Nikolaos K. Gatselis, Pinelopi Arvaniti, George K. Koukoulis |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Alcoholic liver disease Cirrhosis Alcohol use disorder Autoimmune hepatitis 030204 cardiovascular system & hematology Gastroenterology 03 medical and health sciences 0302 clinical medicine immune system diseases Internal medicine Biopsy Internal Medicine medicine Humans Prospective Studies 030212 general & internal medicine Liver Diseases Alcoholic Retrospective Studies medicine.diagnostic_test business.industry Autoantibody Middle Aged medicine.disease digestive system diseases Hepatitis Autoimmune Liver Cohort Differential diagnosis business |
| Zdroj: | European Journal of Internal Medicine. 85:86-91 |
| ISSN: | 0953-6205 |
| Popis: | Aims Differential diagnosis of autoimmune hepatitis (AIH) incorporates various liver diseases, including alcoholic liver disease (ALD). We report on clinical, laboratory and outcome characteristics of AIH patients who were initially referred as ALD based on increased alcohol consumption (AIH/ALD). Methods From 2000-2019, we retrospectively identified 12 AIH/ALD patients [9 males, age: 61 (30-73) years] in our prospective data base of 317 AIH patients. Results AIH diagnosis was based on aminotransferases elevation in 10 patients, high IgG in 8, compatible autoantibody profile in all and typical/compatible histology in all 9 with available biopsy. There were no significant differences of baseline demographics, presentation, cirrhosis at diagnosis, response to treatment and simplified score compared to 45 age- and sex-matched AIH patients without alcohol consumption and 44 age- and sex-matched ALD patients. However, the AIH/ALD cohort was characterized by more frequent progression to cirrhosis, higher liver-related deaths and overall mortality compared to AIH, though similar to the ALD group. AST/ALT ratio>1 seems to bear a good positive (0.84) and negative predictive value (0.88) for ALD and AIH diagnosis, respectively, but cannot help in discriminating the AIH/ALD variant. Conclusions AIH should not be forgotten in patients with alcohol use when clinical and laboratory features hint towards the diagnosis of AIH/ALD variant as this group seems to have worse outcome compared to those with AIH alone suggesting the need for closer follow-up and surveillance. Reliable autoantibody testing and cautious interpretation of liver histology appear mandatory for AIH diagnosis in these difficult to diagnose cases. |
| Databáze: | OpenAIRE |
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