RT Journal Article
SR Electronic
T1 Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH)
JF Frontline Gastroenterology
JO Frontline Gastroenterol
FD BMJ Publishing Group Ltd
SP flgastro-2020-101661
DO 10.1136/flgastro-2020-101661
A1 Victoria Mary Gordon
A1 Ratul Adhikary
A1 Guruprasad P Aithal
A1 Victoria Appleby
A1 Debasish Das
A1 James Day
A1 Toby Delahooke
A1 Selena Dixon
A1 David Elphick
A1 Claire Hardie
A1 Michael Heneghan
A1 Barbara Hoeroldt
A1 Patricia Hooper
A1 John Hutchinson
A1 Rebecca L Jones
A1 Faisal Khan
A1 Jane Metcalf
A1 Alick Nkhoma
A1 Stavroula Pelitari
A1 Martin Prince
A1 Annell Prosser
A1 Sushma Saksena
A1 Vinay Sathyanarayana
A1 Deven Vani
A1 Andrew Yeoman
A1 Dermot Gleeson
YR 2021
UL http://fg.bmj.com/content/early/2021/05/18/flgastro-2020-101661.abstract
AB Background Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals.Methods Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.Results Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3–23) gastroenterologists; including 3 (0–10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18–100) of all consultants managing AIH: in DGH’s 92% (20–100) vs 46% (17–100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital.Conclusion Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data access for research purposes must be requested from Dr Vikki Gordon: victoria.gordon@uhcw.nhs.uk.