Early Morning Workshop, April 1, 2011 “Management of Autoimmune Hepatitis” The International Liver Congress TM 2011 46 th Annual Meeting of EASL, March 30- April 3, 2011, Berlin George N. Dalekos, MD, PhD Professor of Medicine Head, Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly Larissa, Greece Prof. Dr. Christoph Schramm I. Medizinische Klinik und Poliklinik, Universitatsklinikum Hamburg-Eppendorf, Hamburg Germany
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“Management of Autoimmune Hepatitis”83.212.32.147/internalmedicine/images/omilies_2011-2/dal_manage… · AIH Classification and Autoantibodies Dalekos et al, Eur J Intern Med
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Early Morning Workshop, April 1, 2011
“Management of Autoimmune Hepatitis”
The International Liver CongressTM 2011
46th Annual Meeting of EASL, March 30- April 3, 2011, Berlin
George N. Dalekos, MD, PhD
Professor of Medicine
Head, Department of Medicine
and Research Laboratory of
Internal Medicine, Medical
School, University of Thessaly
Larissa, Greece
Prof. Dr. Christoph Schramm
I. Medizinische Klinik und
Poliklinik, Universitatsklinikum
Hamburg-Eppendorf,
Hamburg
Germany
Early Morning Workshop, April 1, 2011
“Management of Autoimmune Hepatitis”
The International Liver CongressTM 2011
46th Annual Meeting of EASL, March 30- April 3, 2011, Berlin
DISCLOSURE SLIDE
“Nothing to disclose”
George N. Dalekos
Professor of Medicine
AUTOIMMUNE HEPATITIS (AIH)
Definition
A chronic (or acute) hepatitis of unknown cause
Progressive Usual Increased
destruction progression mortality
of the liver to cirrhosis (if untreated)
Krawitt E N Engl J Med 2006, Zachou et al J
Autoimm Dis 04, Dalekos et al Eur J Gastro
Hepatol 02, Eur J Intern Med 02, J Hepatol 98
Manns MP et al Hepatology 2010, Czaja et al
Gastroenterology 2010
Autoimmune hepatitis is a rare disease
in young women
EPIDEMIOLOGY OF AIH
32
21
31
23
18
14
7
0
5
10
15
20
25
30
35
0-19 20-29 30-39 40-49 50-59 60-69 > 70
Number ofpatients
Epidemiology of AIH: Age distribution at presentation
Dalekos et al, unpublished prospective data 2010
20-25% males
• Occurs in all countries and races
• Affects all age groups
• Prevalence: 17-20/ 105 population (N. Europe/ USA)
• Up to 200.000 cases of AIH in USA (10-23% of CAH)
• 43/ 105 population in Alaska Natives !!
• Female predominance (F/M: 4-6/1)
• Different HLA-associations
EPIDEMIOLOGY OF AIH
Boberg KM Clin Liver Dis 02; Hurlburt et al AJG 02; Muratori et al Mol
Asp Med 08; Gupta et al JGH 01; Choudhuri et al BMC Gastro 05;
Werner et al Scan J Gastro 08; Koay et al Dig Dis Sci 06
AIH: Clinical Characteristics
There is no characteristic clinical sign or symptom
• Most cases (60%) have an insidious onset with one
or more of non-specific symptoms and fluctuating
course like arthralgias, fatigue, acne, weight loss,
malaise, anorexia or low-grade fever
• Acute hepatitis (20-30%) or FHF (rarely)
• Asymptomatic disease (10-20% ??)
Laboratory Abnormalities in ΑIΗ
There are no diagnostic abnormalities
AST/ALT (0.5 - 50x UNL)
Bilirubin (0.5 - 50x UNL)
γ-globulins (IgG; 1.1 – 5.0x UNL)*
ALP normal or moderate increase
* Unfortunately their determination is usually forgotten; Normal
values can be found in acute cases or in the elderly
AIH: Clinical example 1
• Female 49y was referred with a diagnosis of NAFLD/NASH
• ΑST: 67-180 U/L & ALT: 53-359 U/L at least for 1y (check-up)