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Nastasio S, Sciveres M, Francalanci P, Maggiore G. Pediatric Autoimmune Hepatitis. Pediatr Rep 2024; 16:110-113. [PMID: 38390999 PMCID: PMC10885090 DOI: 10.3390/pediatric16010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
Pediatric autoimmune hepatitis (PAIH) is a rare necro-inflammatory disease of the liver of unknown etiology thought to derive from the dysregulation of the immune response upon exposure to environmental triggers in genetically predisposed individuals [...].
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Affiliation(s)
- Silvia Nastasio
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Marco Sciveres
- Pediatric Department and Transplantation, ISMETT, 90133 Palermo, Italy
| | - Paola Francalanci
- Division of Pathology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giuseppe Maggiore
- Division of Hepatogastroenterology, and Liver Transplant, ERN RARE LIVER, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Islek A, Tumgor G. Seronegative autoimmune hepatitis in childhood. World J Clin Pediatr 2023; 12:77-85. [PMID: 37342447 PMCID: PMC10278082 DOI: 10.5409/wjcp.v12.i3.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
Comprehensive guidelines on seropositive autoimmune hepatitis have been published for both adults and children, although these guidelines comprise only limited knowledge about seronegative autoimmune hepatitis. Autoimmune hepatitis presents as an acute or chronic progressive disease and poor outcomes are inevitable if left untreated. The absence of autoantibody positivity, hypergammaglobulinemia and lack of comprehensive algorithms makes seronegative autoimmune hepatitis a mysterious disease. In general, seronegative autoimmune hepatitis often presents with acute hepatitis, and its treatment and prognosis similar to seropositive autoimmune hepatitis. The present review focuses on the known characteristics of seronegative autoimmune hepatitis in childhood, and those of which current knowledge is vague.
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Affiliation(s)
- Ali Islek
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
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Duclos-Vallée JC, Debray D, De Martin E, Beux EL, Louvet A. Best practice guidelines for France regarding the diagnosis and management of autoimmune hepatitis. Clin Res Hepatol Gastroenterol 2022; 46:101871. [PMID: 35108657 DOI: 10.1016/j.clinre.2022.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm Unité 1193, Université Paris-Saclay, FHU Hépatinov, Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes, Villejuif, France.
| | - Dominique Debray
- Assistance Publique-Hôpitaux de Paris, University de Paris, Pediatric Liver Unit, Necker Hospital, Expert Center for Bile Duct Inflammatory Diseases and Autoimmune Hepatitis (FilFoie)
| | - Eleonora De Martin
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm Unité 1193, Université Paris-Saclay, FHU Hépatinov, Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes, Villejuif, France
| | - Emilie Le Beux
- Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes, Saint-Antoine Hospital, Paris, France
| | - Alexandre Louvet
- Service des Maladies de l'Appareil Digestif, Hôpital Claude-Huriez, Lille University Hospital, France, Centre de Référence Maladies Inflammatoires des Voies Biliaires et Hépatites Auto-Immunes (FilFoie)
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Muratori P, Granito A, Lenzi M, Muratori L. Limitation of the simplified scoring system for the diagnosis of autoimmune Hepatitis with acute onset. Liver Int 2021; 41:529-534. [PMID: 33389800 DOI: 10.1111/liv.14778] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022]
Abstract
Autoimmune Hepatitis (AIH) is a chronic inflammatory liver disease of unknown aetiology characterized by the presence of autoantibodies, hypergammaglobulinaemia with specific IgG increase and interface hepatitis on liver histology. The clinical course of AIH is classically characterized by fluctuating periods of decreased or increased disease activity and therefore its clinical spectrum is variable ranging from no symptoms to severe acute hepatitis and even fulminant hepatic failure. Acute presentation may not differ from acute hepatitis of other causes and diagnosis can be difficult. We describe our experience on diagnostic performance of the two AIH scoring systems in acute onset of AIH and found that revised version of the original criteria (1999) achieves the diagnosis in about 30% of patients who presented with normal IgG serum levels and lower frequency of autoantibody positivity in whom the simplified score did not allow the diagnosis.
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Affiliation(s)
- Paolo Muratori
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, Bologna, Italy.,Department of Science for the Quality of Life, University of Bologna, Bologna, Italy
| | - Alessandro Granito
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, Bologna, Italy.,Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Marco Lenzi
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, Bologna, Italy.,Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Luigi Muratori
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, Bologna, Italy.,Department of Medicine and Surgery, University of Bologna, Bologna, Italy
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Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology 2020; 72:671-722. [PMID: 31863477 DOI: 10.1002/hep.31065] [Citation(s) in RCA: 429] [Impact Index Per Article: 107.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Cara L Mack
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - David Adams
- Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - David N Assis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Nanda Kerkar
- Golisano Children's Hospital at Strong, University of Rochester Medical Center, New York, NY
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Marlyn J Mayo
- Division of Digestive and Liver Diseases, University of Texas SW Medical Center, Dallas, TX
| | - John M Vierling
- Medicine and Surgery, Baylor College of Medicine, Houston, TX
| | | | - Mohammad H Murad
- Mayo Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, MN
| | - Albert J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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Abstract
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease, characterized by the elevation of aminotransferases, presence of anti-nuclear antibody or anti-smooth muscle antibody, elevated immunoglobulin G (IgG), and interface hepatitis/plasma-lymphocytic inflammation based on histology. Recent epidemiological studies have indicated an increasing trend in the prevalence of AIH worldwide, especially in male patients; this trend may suggest the alteration of environmental triggers of disease onset over time. As no disease-specific biomarker or histological finding is currently available, AIH requires a clinical diagnosis, and a validated diagnostic scoring system with acceptable specificity and sensitivity has been proposed. Regarding treatment, corticosteroids and azathioprine are recommended, and in those who exhibit an incomplete response or those who are intolerant to these drugs, second-line therapy, such as mycophenolate mofetil, is considered. Overall, the long-term outcome is excellent in patients with complete biochemical responses, while life-long maintenance treatment may be required since the cessation of immunosuppressive agents frequently leads to the relapse of the disease. Acute-onset AIH does occur, and the diagnosis is very challenging due to the lack of serum autoantibodies or elevated IgG. The unmet needs include earlier diagnosis, intervention with disseminated clinical practice guidelines, and recognition and improvement of patients’ health-related quality of life with the development of novel corticosteroid-free treatment regimens.
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Affiliation(s)
- Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Arcos-Machancoses JV, Molera Busoms C, Julio Tatis E, Bovo MV, Quintero Bernabeu J, Juampérez Goñi J, Crujeiras Martínez V, Martín de Carpi J. Development and validation of a new simplified diagnostic scoring system for pediatric autoimmune hepatitis. Dig Liver Dis 2019; 51:1308-1313. [PMID: 30928421 DOI: 10.1016/j.dld.2019.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with autoimmune hepatitis (AIH) often exhibit particular features. Accordingly, seven pediatric-specific criteria have been proposed. AIM To develop a prediction model based on them, transform it into a scoring system and study its accuracy. METHODS A cohort of children under study for liver disease was consecutively selected. AIH diagnosis was based on classical criteria. Already proposed pediatric criteria were recorded. The best possible regression model was selected, and the beta coefficient of each criterion was translated into a whole number (points). Total scores were obtained following the points system and the best cut-off was calculated. Subsequently, accuracy of the diagnostic score was studied in the validation set. RESULTS Among 212 included patients, 100 had AIH. The score included 5 criteria: autoantibodies (0-2 points), hypergammaglobulinemia, exclusion of viral hepatitis, exclusion of Wilson's disease (1 point each) and liver histology (3 points). In addition, a normal cholangiogram is mandatory. The validation set was formed of 70 patients (24 with AIH). In this subsample, a score of ≥6 renders a sensitivity/specificity of 95.8%/100%. The area under the receiver operating characteristic curve was 97.1%. CONCLUSION Pediatric-specific criteria for the diagnosis of AIH can be reliably used as a scoring system.
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Affiliation(s)
| | - Cristina Molera Busoms
- Sant Joan de Déu Hospital (HSJD), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain; HSJD-HVH Comprehensive Unit of Complex Hepatology and Pediatric Liver Transplantation, Barcelona, Spain.
| | - Ecaterina Julio Tatis
- Sant Joan de Déu Hospital (HSJD), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain.
| | - María Victoria Bovo
- Sant Joan de Déu Hospital (HSJD), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain.
| | - Jesús Quintero Bernabeu
- Vall d'Hebron Hospital (HVH), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain; HSJD-HVH Comprehensive Unit of Complex Hepatology and Pediatric Liver Transplantation, Barcelona, Spain.
| | - Javier Juampérez Goñi
- Vall d'Hebron Hospital (HVH), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain; HSJD-HVH Comprehensive Unit of Complex Hepatology and Pediatric Liver Transplantation, Barcelona, Spain.
| | - Vanessa Crujeiras Martínez
- University Hospital Complex of Santiago de Compostela, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Spain.
| | - Javier Martín de Carpi
- Sant Joan de Déu Hospital (HSJD), Department of Pediatric Gastroenterology, Hepatology and Nutrition, Barcelona, Spain; HSJD-HVH Comprehensive Unit of Complex Hepatology and Pediatric Liver Transplantation, Barcelona, Spain.
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