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Variant forms of autoimmune hepatitis

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Abstract

Variant forms of autoimmune hepatitis have features that are intermixed with another disorder (overlap syndrome) or findings that are inconsistent with or insufficient for a confident diagnosis of classic disease (outlier syndrome). Diagnostic criteria have not been codified, but application of a modified scoring system provides a template that can be combined with clinical findings to ensure uniform evaluation and classification. Variant forms are frequently assimilated into conventional diagnostic categories. and they may distort analyses of natural history and outcome. Management strategies are empiric, based on an assessment of the predominant characteristics and institution of the most appropriate drug regimen. Patients with variant syndromes who respond to corticosteroids typically have serum alkaline phosphatase levels of less than twofold the upper limit of normal at presentation. By distinguishing between these syndromes, further insights into natural history, genetic predisposition, and immunopathic mechanisms are possible.

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References and Recommended Reading

  1. Johnson PJ, McFarlane IG, Alvarez F, et al.: Meeting Report. International Autoimmune Hepatitis Group. Hepatology 1993, 18:998–1005.

    Article  PubMed  CAS  Google Scholar 

  2. Czaja AJ: Chronic active hepatitis: the challenge for a new nomenclature. Ann Intern Med 1993, 119:510–517.

    PubMed  CAS  Google Scholar 

  3. Czaja AJ: The variant forms of autoimmune hepatitis. Ann Intern Med 1996, 125:588–598.

    PubMed  CAS  Google Scholar 

  4. Kenny RP, Czaja AJ, Ludwig J, et al.: Frequency and significance of antimitochondrial antibodies in severe chronic active hepatitis. Dig Dis Sci 1986, 31:705–711.

    Article  PubMed  CAS  Google Scholar 

  5. Czaja AJ, Carpenter HA, Manns MP: Antibodies to soluble liver antigen, P450IID6, and mitochondrial complexes in chronic hepatitis. Gastroenterology 1993, 105:1522 1528.

    PubMed  Google Scholar 

  6. Ludwig J, Czaja AJ, Dickson ER, et al.: Manifestations of nonsuppurative cholangitis in chronic hepatobiliary disease: morphologic spectrum, clinical correlations and terminology. Liver 1984, 4:105–116.

    PubMed  CAS  Google Scholar 

  7. Perdigoto R, Carpenter HA, Czaja AJ: Frequency and significance of chronic ulcerative colitis in severe corticosteroidtreated autoimmune hepatitis. J Hepatol 1992, 14:325–331.

    Article  PubMed  CAS  Google Scholar 

  8. Czaja AJ, Hay JE, Rakela J: Clinical features and prognostic implications of severe corticosteroid-treated cryptogenic chronic active hepatitis. Mayo Clin Proc 1990, 65:23–30.

    PubMed  CAS  Google Scholar 

  9. Czaja AJ, Magrin S, Fabiano C, et al.: Hepatitis C virus infection as a determinant of behavior in type 1 autoimmune hepatitis. Dig Dis Sci 1995, 40:33–40.

    Article  PubMed  CAS  Google Scholar 

  10. Czaja AJ, Carpenter HA: Validation of a scoring system for the diagnosis of autoimmune hepatitis. Dig Dis Sci 1996, 41:305–314.

    Article  PubMed  CAS  Google Scholar 

  11. Czaja AJ: Frequency and nature of the variant syndromes of autoimmune liver disease. Hepatology 1998, 28:360–365. The diagnostic criteria, frequency of occurrence, clinical distinctions from definite autoimmune hepatitis, and results of conventional corticosteroid therapy are presented for the variant syndromes of autoimmune hepatitis and PBC, autoimmune hepatitis and PSC, an autoimmune cholangitis.

    Article  PubMed  CAS  Google Scholar 

  12. Wee A, Ludwig J: Pericholangitis in chronic ulcerative colitis: primary sclerosing cholangitis of the small bile ducts? Ann Intern Med 1985, 102:581–587.

    PubMed  CAS  Google Scholar 

  13. Czaja AJ, Carpenter HA, Santrach PJ, et al.: Evidence against hepatitis viruses as important causes of severe autoimmune hepatitis in the United States. J Hepatol 1993, 18:342–352.

    Article  PubMed  CAS  Google Scholar 

  14. Czaja AJ, Carpenter HA, Santrach PJ, et al.: Immunologic features and HLA associations in chronic viral hepatitis. Gastroenterology 1995, 108:157–164.

    Article  PubMed  CAS  Google Scholar 

  15. Czaja AJ, Carpenter HA, Santrach PJ, et al.: Significance of human leukocyte antigens DR3 and DR4 in chronic viral hepatitis. Dig Dis Sci 1995, 40:2098–2106.

    Article  PubMed  CAS  Google Scholar 

  16. Czaja AJ: Autoimmune hepatitis and viral infection. Gastroenterol Clin North Am 1994, 23:547–566.

    PubMed  CAS  Google Scholar 

  17. Papo T, Marcellin P, Bernuau J, et al.: Autoimmune chronic hepatitis exacerbated by alpha-interferon. Ann Intern Med 1992, 116:51–53.

    PubMed  CAS  Google Scholar 

  18. Magrin S, Craxi A, Fabiano C, et al.: Hepatitis C viremia in chronic liver disease: relationship to interferon-alpha or corticosteroid therapy. Hepatology 1994, 19:273–279.

    PubMed  CAS  Google Scholar 

  19. Czaja AJ, Carpenter HA: Sensitivity, specificity and predictability of biopsy interpretations in chronic hepatitis. Gastroenterology 1993, 105:1824–1832.

    PubMed  CAS  Google Scholar 

  20. Czaja AJ, Carpenter HA: Histological findings in chronic hepatitis C with autoimmune features. Hepatology 1997, 26:459–466. The histological patterns associated with chronic hepatitis C are correlated with the clinical and laboratory features of immunoreactivity and HLA risk factors for immune expression. Patients with true HCV infection and histologic patterns that resemble autoimmune hepatitis may have predominant immunopathic mechanisms.

    Article  PubMed  CAS  Google Scholar 

  21. Bellary S, Schiano T, Hartman G, et al.: Chronic hepatitis with combined features of autoimmune chronic hepatitis and chronic hepatitis C: favorable response to prednisone and azathioprine. Ann Intern Med 1995, 123:32–34.

    PubMed  CAS  Google Scholar 

  22. Tran A, Benzaken S, Yang G et al.: Chronic hepatitis C and autoimmunity: good response to immunosuppressive therapy. Dig Dis Sci 1997, 42:778–780. Chronic hepatitis C infection that coexists with immune manifestations may be responsive to corticosteroid therapy.

    Article  PubMed  CAS  Google Scholar 

  23. Saracco G, Touscoz A, Durazzo M, et al.: Antibodies and response to alpha-interferon in patients with chronic viral hepatitis. J Hepatol 1990, 11:339–343.

    Article  PubMed  CAS  Google Scholar 

  24. Clifford BD, Donahue D, Smith L, et al.: High prevalence of serological markers of autoimmunity in patients with chronic hepatitis C. Hepatology 1995, 21:613–619.

    PubMed  CAS  Google Scholar 

  25. Ben-Ari Z, Dhillon AP, Sherlock S: Autoimmune cholangiopathy: part of the spectrum of autoimmune chronic active hepatitis. Hepatology 1993, 18:10–15.

    PubMed  CAS  Google Scholar 

  26. Michieletti P, Wanless IR, Katz A, et al.: Antimitochondrial antibody negative primary biliary cirrhosis: a distinct syndrome of autoimmune cholangitis. Gut 1994, 35:260–265.

    PubMed  CAS  Google Scholar 

  27. Taylor SL, Dean PJ, Riely CA: Primary autoimmune cholangitis: an alternative to antimitochondrial antibody-negative primary biliary cirrhosis. Am J Clin Pathol 1994, 18:91–99.

    CAS  Google Scholar 

  28. Lacerda MA, Ludwig J, Dickson ER, et al.: Antimitochondrial antibody-negative primary biliary cirrhosis. Am J Gastroenterol 1995, 90:247–249.

    PubMed  CAS  Google Scholar 

  29. Goodman ZD, McNally PR, Davis DR, et al.: Autoimmune cholangitis: a variant of primary biliary cirrhosis. Clinicopathologic and serologic correlations in 200 cases. Dig Dis Sci 1995, 40:1232–1242.

    Article  PubMed  CAS  Google Scholar 

  30. Gordon SC, Quattrociocchi-Longe TM, Khan BA, et al.: Antibodies to carbonic anhydrase in patients with immune cholangiopathies. Gastroenterology 1995, 108:1802–1809.

    Article  PubMed  CAS  Google Scholar 

  31. Muratori P, Muratori L, Lenzi M, et al.: Antibodies to carbonic anhydrase in autoimmune cholangiopathy. Gastroenterology 1997, 112:1053–1059. The specificity of antibodies to carbonic anhydrase for autoimmune cholangitis is assessed in liver and nonliver diseases, using the assay originally ascribed a discriminatory value, and it is found to be low.

    Article  PubMed  CAS  Google Scholar 

  32. Tsuneyama K, Van de Water J, Van Thiel D, et al.: Abnormal expression of PDC-E2 on the apical surface of biliary epithelial cells in patients with antimitochondrial antibody-negative primary biliary cirrhosis. Hepatology 1995, 22:1440–1446.

    PubMed  CAS  Google Scholar 

  33. Invernizzi P, Crosignani A, Battezzati PM, et al.: Comparison of the clinical features and clinical course of antimitochondrial antibody-positive and-negative primary biliary cirrhosis. Hepatology 1997, 25:1090–1095. The first report to compare the clinical courses of AMA-negative an AMA-positive primary biliary cirrhosis and demonstrate their comparability. The implication is that autoimmune cholangitis is not a clinical entity distinct from PBC.

    Article  PubMed  CAS  Google Scholar 

  34. Stone J, Wade JA, Cauch-Dudek K, et al.: Genomic associations in AMA-positive and AMA-negative primary biliary cirrhosis [abstract]. Gastroenterology 1998, 114:1346.

    Article  Google Scholar 

  35. Czaja AJ, Carpenter HA, Santrach PJ, et al.: The nature and prognosis of severe cryptogenic chronic active hepatitis. Gastroenterology 1993, 104:1755–1761.

    PubMed  CAS  Google Scholar 

  36. Stechemesser E, Klein R, Berg PA: Characterization and clinical relevance of liver-pancreas antibodies in autoimmune hepatitis. Hepatology 1993, 18:1–9.

    Article  PubMed  CAS  Google Scholar 

  37. Abuaf N, Johanet C, Chretien P, et al.: Characterization of the liver cytosol antigen type 1 reacting with autoantibodies in chronic active hepatitis. Hepatology 1992, 16:892–898.

    Article  PubMed  CAS  Google Scholar 

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Czaja, A.J. Variant forms of autoimmune hepatitis. Curr Gastroenterol Rep 1, 63–70 (1999). https://doi.org/10.1007/s11894-999-0089-0

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