scholarly journals Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000701
Author(s):  
Pimsiri Sripongpun ◽  
Ananya Pongpaibul ◽  
Phunchai Charatcharoenwitthaya
Keyword(s):  
Liver Biopsy ◽  
Autoimmune Hepatitis ◽  
Significant Risk ◽  
Clinical Information ◽  
Diagnostic Information ◽  
Overlap Syndrome ◽  
Clinical Suspicion ◽  
Primary Biliary Cholangitis ◽  
Percutaneous Liver Biopsy ◽  
Liver Biopsies

ObjectiveThe decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and complications of percutaneous liver biopsy in cirrhosis for differentiating AIH from other liver conditions.MethodsA clinicopathological database of patients undergoing percutaneous liver biopsies for suspected AIH (unexplained hepatitis with elevated γ-globulin and autoantibody seropositivity) was reviewed to identify patients presenting with cirrhosis. Biopsy slides were reviewed by an experienced hepatopathologist who was blinded to clinical data.ResultsIn 207 patients who underwent liver biopsy for suspected AIH, 59 patients (mean age: 59.0±12.0 years, 83.1% female) had clinically diagnosis of cirrhosis. Mean Child-Turcotte-Pugh score was 6.6±1.6, and 44% of patients had a Child-Turcotte-Pugh score≥7. According to the revised International AIH Group (IAIHG) criteria, histology assessment combined with clinical information facilitated a diagnosis of AIH or overlap syndrome of AIH and primary biliary cholangitis (PBC) in 81.4% of cases. Liver biopsy identified other aetiologies, including PBC (n=2), non-alcoholic steatohepatitis (n=6) and cryptogenic cirrhosis (n=3). A reliable diagnosis of AIH could be made using histological category of the simplified criteria in 69.2% and 81.8% of cases using IAIHG scores before biopsy of <10 and 10–15, respectively. Three patients with cirrhosis (5.1%) experienced bleeding following biopsy, but none of 148 patients with non-cirrhosis had bleeding complication (p=0.022).ConclusionLiver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected AIH, but the procedure is associated with significant risk.

Tu1007 The Role and Safety of Percutaneous Liver Biopsy in Cirrhotic Patients With Clinical Suspicion of Autoimmune Hepatitis

2013 ◽  
Vol 144 (5) ◽  
pp. S-1030
Author(s):  
Phunchai Charatcharoenwitthaya ◽  
Pimsiri Sripongpun ◽  
Ananya Pongpaibul ◽  
Nonthalee Pausawasdi ◽  
Siwaporn P. Chainuvati
Keyword(s):  
Liver Biopsy ◽  
Autoimmune Hepatitis ◽  
Clinical Suspicion ◽  
Percutaneous Liver Biopsy ◽  
Cirrhotic Patients

scholarly journals Primary biliary cholangitis‐autoimmune hepatitis overlap syndrome: Case report and literature review

2021 ◽  
Author(s):  
Chantelli Iamblaudiot Razafindrazoto ◽  
Andry Lalaina Rinà Rakotozafindrabe ◽  
Nitah Harivony Randriamifidy ◽  
Anjaramalala Sitraka Rasolonjatovo ◽  
Tovo Harimanana Rabenjanahary ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Autoimmune Hepatitis ◽  
Overlap Syndrome ◽  
Primary Biliary Cholangitis

scholarly journals Autoimmune Hepatitis–Primary Biliary Cholangitis Overlap Syndrome Triggered by COVID-19

2021 ◽  
Author(s):  
Balraj Singh ◽  
Parminder Kaur ◽  
Michael Maroules
Keyword(s):  
Autoimmune Hepatitis ◽  
Multiple Organ ◽  
Overlap Syndrome ◽  
Beta Thalassemia ◽  
Primary Biliary Cholangitis ◽  
Smooth Muscle Antibody ◽  
Elevated Liver Enzymes ◽  
Thalassemia Minor ◽  
Wide Range ◽  
Mitochondrial Antibody

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection, has caused the ongoing global pandemic. Initially considered a respiratory disease, it can manifest with a wide range of complications (gastrointestinal, neurological, thromboembolic and cardiovascular) leading to multiple organ dysfunction. A range of immune complications have also been described. We report the case of a 57-year-old man with a medical history of hypertension, prediabetes and beta thalassemia minor, who was diagnosed with COVID-19 and subsequently developed fatigue and arthralgias, and whose blood work showed hyperferritinemia, elevated liver enzymes (AST/ALT/GGT), hypergammaglobulinemia, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-double-stranded DNA antibodies. The patient was diagnosed with autoimmune hepatitis–primary biliary cholangitis overlap syndrome triggered by COVID-19. To our knowledge, this is the first such case reported.

scholarly journals Autoimmune Hepatitis with Concomitant Idiopathic Thrombocytopenic Purpura Diagnosed by Transjugular Liver Biopsy

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Hiromi Fukuda ◽  
Kazuhide Takata ◽  
Takanori Kitaguchi ◽  
Ryo Yamauchi ◽  
Hideo Kunimoto ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Biopsy ◽  
Autoimmune Hepatitis ◽  
Histological Examination ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Liver Dysfunction ◽  
Severe Thrombocytopenia ◽  
Percutaneous Liver Biopsy ◽  
Thrombocytopenic Purpura ◽  
Transjugular Liver Biopsy

Patients with autoimmune hepatitis (AIH) may sometimes have concomitant idiopathic thrombocytopenic purpura (ITP). Severe thrombocytopenia in ITP interferes with percutaneous liver biopsy for pathological diagnosis of AIH. Here, we report a case of AIH with ITP in a 63-year-old woman. The patient presented to our hospital with liver dysfunction and thrombocytopenia. For histological examination, transjugular liver biopsy (TJLB) was performed, leading to a diagnosis of AIH. Corticosteroids treatment led to an improvement in her liver enzyme levels and platelet count. In conclusion, patients with AIH may sometimes have concomitant ITP. TJLB was effective for making the diagnosis of AIH with severe thrombocytopenia due to ITP.

scholarly journals Dysregulation of Circulating FGF19 and Bile Acids in Primary Biliary Cholangitis-Autoimmune Hepatitis Overlap Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Zhanyi Li ◽  
Yu Liu ◽  
Fangji Yang ◽  
Jiahui Pang ◽  
Yuankai Wu ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Bile Acids ◽  
Overlap Syndrome ◽  
Primary Biliary Cholangitis ◽  
Strongly Correlated ◽  
Adequate Treatment ◽  
End Stage ◽  
Fibroblast Growth Factor 19 ◽  
Total Bile Acids

Background. Primary biliary cholangitis-autoimmune hepatitis overlap syndrome (PBC-AIH OS), which exhibits features between autoimmune hepatitis and cholestasis, is a common condition and usually shows a progressive course toward cirrhosis and liver failure without adequate treatment. Synthesis of bile acids (BAs) plays an important role in liver injury in cholestasis, and the process is regulated by fibroblast growth factor 19 (FGF19). The overall role of circulating FGF19 in BA synthesis and PBC-AIH OS requires further investigation. Methods. We analyzed BA synthesis and correlated clinical parameters with serum BAs and FGF19 in 35 patients with PBC-AIH OS. Serum concentrations of 7alpha-hydroxycholest-4-en-3-one (C4) were used to quantify the synthesis of BA directly. Results. Serum FGF19 levels were higher, while C4 levels were substantially lower in PBC-AIH OS patients than those in healthy controls. Circulating FGF19 levels strongly correlated with C4 (r=−0.695, p<0.0001), direct bilirubin (r=0.598, p=0.0001), and total bile acids (r=0.595, p=0.002). Moreover, circulating FGF19 levels strongly correlated with the model for end-stage liver disease score (r=0.574, p=0.0005) and Mayo risk score (r=0.578, p=0.001). Conclusions. Serum FGF19 is significantly increased in patients with PBC-AIH OS, while BA synthesis is suppressed. Circulating FGF19 primarily controls the regulation of BA synthesis in response to cholestasis and under cholestatic conditions. Therefore, modulation of circulating FGF19 could provide a promising targeted therapy for patients with PBC-AIH OS.

Primary Biliary Cholangitis- Autoimmune Hepatitis Overlap Syndrome

2018 ◽  
Vol 85 (9) ◽  
pp. 803-805
Author(s):  
Pratin Bhatt ◽  
Deepak Kumar Gupta ◽  
Nitin Ramani ◽  
Pratik Tibdewal ◽  
Abhishek Sadalage ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Overlap Syndrome ◽  
Primary Biliary Cholangitis

scholarly journals Resolution of HCV-Autoimmune Hepatitis Overlap Syndrome With Antiviral TreatmentA Paired Liver Biopsy Study

2019 ◽  
Vol 152 (6) ◽  
pp. 735-741
Author(s):  
Juan Putra ◽  
Thomas D Schiano ◽  
M Isabel Fiel
Keyword(s):  
Autoimmune Hepatitis ◽  
Plasma Cells ◽  
Antiviral Agents ◽  
Virologic Response ◽  
Overlap Syndrome ◽  
High Power Field ◽  
Direct Acting Antiviral ◽  
Before And After ◽  
Liver Biopsies ◽  
Direct Acting

Abstract Objectives To evaluate histologic changes occurring in patients having chronic hepatitis C and autoimmune hepatitis overlap (HCV-AIH), and who achieved virologic cure using direct-acting antiviral agents (DAA). Methods Characteristics of HCV-AIH patients who underwent paired liver biopsies before and after receiving DAA treatment from 2011 to 2018 were evaluated. Results Five HCV-AIH patients (three male; mean age, 60.4 years) underwent paired liver biopsies (average interval, 2.3 years) before and after achieving cure with DAA treatment. All patients showed virologic response, while four showed decreased inflammation, and three cases showed features of fibrosis regression. Immunohistochemical staining demonstrated significant decrease in plasma cell count in three patients (20.6 vs 11.9 plasma cells/high power field; P = .02, t test). Conclusions Histologic improvements in inflammation and fibrosis are noted in most HCV-AIH patients after DAA treatment, suggesting that the autoimmune component of the HCV-AIH overlap syndrome is merely a secondary phenomenon of viral infection.

scholarly journals A study of liver biopsies and liver disease among hemophiliacs

Blood ◽  
1985 ◽  
Vol 66 (2) ◽  
pp. 367-372 ◽  
Author(s):  
LM Aledort ◽  
PH Levine ◽  
M Hilgartner ◽  
P Blatt ◽  
JA Spero ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Chronic Active Hepatitis ◽  
Ad Hoc ◽  
Clinical Information ◽  
Severe Liver ◽  
Severe Liver Disease ◽  
Liver Biopsies ◽  
Clinically Significant ◽  
The Relationship

Abstract Hepatic histologic materials (biopsy or autopsy) and associated clinical data from 155 hemophiliacs were collected by an ad hoc hemophilia study group and analyzed retrospectively in an effort to determine the spectrum of liver disease in this population and to examine the relationship between the severity of liver disease and treatment history. Clinical information on the frequency of complications from 126 biopsies in 115 hemophilic patients provided a unique opportunity to assess the safety of liver biopsy in such patients. The incidence of cirrhosis (15%) and chronic active hepatitis (7%) was lower than previously reported. The frequency of severe liver disease (chronic active hepatitis or cirrhosis) in patients receiving large pooled concentrates was no greater than in patients treated principally with cryoprecipitate or plasma. The risks of liver biopsy in this setting are relatively high: clinically significant hemorrhage followed 12.5% of the procedures.

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