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Ist die Diagnose einer autoimmunen Hepatitis nur durch eine zusätzliche Leberbiopsie möglich?

Is the diagnosis of autoimmune hepatitis only possible by an additional liver biopsy?

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Zusammenfassung

Die autoimmune Hepatitis (AIH) ist eine Erkrankung ohne einen einzelnen beweisenden diagnostischen Test, was eine konsequente Ausschlussdiagnostik notwendig macht. Obwohl es keine eindeutig beweisenden histologischen Kriterien einer AIH gibt, ist die Leberbiopsie unverzichtbarer Bestandteil der Diagnostik, deren Ziel eine verlässliche Beschreibung der Krankheitswahrscheinlichkeit mit therapeutischen und prognostischen Konsequenzen darstellt. Internationale Leitlinien empfehlen eine histologische Begutachtung, und der vereinfachte AIH-Diagnosescore ermöglicht ohne Histologie keine definitive Diagnose einer AIH. Für die Definition von Überlappungssyndromen, fulminante AIH-Verläufe und deren Abgrenzung, Auslassversuche und die Diagnostik nach Lebertransplantation ist die Leberhistologie notwendig.

Abstract

Autoimmune hepatitis (AIH) is a disease without a single diagnostic test capable of proving the diagnosis. Therefore, the diagnosis of AIH depends upon the consequent exclusion of other causes of liver disease. Although there are no unequivocal histological features that can prove AIH, liver histology represents a necessary component of the diagnostic work-up leading to the reliable description of a disease probability with therapeutic and prognostic consequences. International guidelines recommend a histological assessment of a liver biopsy, and the simplified diagnostic criteria for AIH no longer permit a definitive diagnosis of AIH without a liver biopsy. For the definition of overlap syndromes, fulminant AIH presentations and their differential diagnoses, treatment withdrawal, and the assessment of recurrence after liver transplantation histology is necessary.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C.P. Strassburg gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    C.P. Strassburg

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Strassburg, C. Ist die Diagnose einer autoimmunen Hepatitis nur durch eine zusätzliche Leberbiopsie möglich?. Gastroenterologe 8, 510–516 (2013). https://doi.org/10.1007/s11377-013-0790-2

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