Original Article

Digestive Diseases and Sciences

, Volume 56, Issue 12, pp 3638-3647

First online:

Efficacy of Intravenous Glycyrrhizin in the Early Stage of Acute Onset Autoimmune Hepatitis

  • Shin YasuiAffiliated withDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University
  • , Keiichi FujiwaraAffiliated withDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University Email author 
  • , Akinobu TawadaAffiliated withDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University
  • , Yoshihiro FukudaAffiliated withDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University
  • , Masayuki NakanoAffiliated withDepartment of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center
  • , Osamu YokosukaAffiliated withDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University

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Abstract

Background

Acute onset autoimmune hepatitis (AIH) shows acute presentation like acute hepatitis and does not have typical clinicopathological features of AIH. There is no gold standard for making the diagnosis. Therefore, losing the timing of starting immunosuppressive therapy, some of the cases develop into severe or fulminant form and have poor prognosis.

Aims

Our aim was to elucidate the efficacy of intravenous glycyrrhizin in decreasing alanine aminotransferase (ALT) level in the early stage of acute onset AIH.

Methods

Thirty-one patients were defined as acute onset AIH based on our uniform criteria, and were enrolled in this study. We prospectively treated 17 patients with sufficient doses (100 ml/day) of intravenous glycyrrhizin (SNMC) at an early stage (SNMC group), and treated 14 patients of severe disease with intravenous glycyrrhizin and corticosteroids (CS) (SNMC + CS group). We examined their clinical and biochemical features and treatment responses.

Results

The ALT level could be controlled at an early stage using SNMC with no significant difference compared with SNMC + CS, and responsiveness to the therapy was determined by the disease severity at the time of starting therapy rather than the time duration from onset to therapy. Recovery rate was higher in the SNMC group than in the SNMC + CS group (P = 0.035).

Conclusions

The early introduction of sufficient doses of SNMC might prevent disease progression in patients with acute onset AIH. SNMC can be used safely and be useful for patients with difficult-to-diagnose acute liver disease as an ‘initial’ treatment tool to improve liver inflammation before starting disease-specific treatments.

Keywords

Autoimmune hepatitis Acute onset Intravenous glycyrrhizin Disease severity