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Curriculum based clinical reviews
Autoimmune hepatitis and complexities in management
  1. Ashnila Janmohamed1,2,
  2. Gideon M Hirschfield1,2,3,4
  1. 1 Centre for Liver Research, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
  2. 2 University Hospitals Birmingham NHS Foundation Trust Birmingham UK, Birmingham, UK
  3. 3 Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
  4. 4 Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
  1. Correspondence to Prof Gideon M Hirschfield, Toronto Centre for Liver Disease, Toronto General Hospital, 9EB-226, University Health Network Toronto, ON, Canada; gideon.hirschfield{at}


Autoimmune hepatitis (AIH) is a rare heterogenous immune-mediated liver disease that for the majority has effective therapy, usually resulting in excellent prognosis. Treatment is based on immunosuppression using standard therapy with corticosteroids and azathioprine. Second-line therapeutic options exist for those who are non-responders (‘difficult to treat AIH’) or intolerant to standard therapy; however, their use is not standardised, and in addition, there is vast variation in practice and efficacy. Given the rarity of AIH, expertise in its management can be limited to large referral programmes. In this case-based review, we aim to discuss common clinical dilemmas encountered by clinicians managing adult patients with AIH and address the related competencies in the 2010 Gastroenterology curriculum.

  • autoimmune hepatitis
  • autoimmune liver disease
  • liver transplantation
  • immune-mediated liver damage
  • immunotherapy

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  • Contributors GMH developed the idea for the article. AJ wrote the article with supervision from GMH. Both authors receive support from the National Institute for Health Research Birmingham Biomedical Research Centre.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests GMH has received speaker fees from Falk Pharma.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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