TY - JOUR T1 - Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH) JF - Frontline Gastroenterology JO - Frontline Gastroenterol DO - 10.1136/flgastro-2020-101661 SP - flgastro-2020-101661 AU - Victoria Mary Gordon AU - Ratul Adhikary AU - Guruprasad P Aithal AU - Victoria Appleby AU - Debasish Das AU - James Day AU - Toby Delahooke AU - Selena Dixon AU - David Elphick AU - Claire Hardie AU - Michael Heneghan AU - Barbara Hoeroldt AU - Patricia Hooper AU - John Hutchinson AU - Rebecca L Jones AU - Faisal Khan AU - Jane Metcalf AU - Alick Nkhoma AU - Stavroula Pelitari AU - Martin Prince AU - Annell Prosser AU - Sushma Saksena AU - Vinay Sathyanarayana AU - Deven Vani AU - Andrew Yeoman AU - Dermot Gleeson Y1 - 2021/05/18 UR - http://fg.bmj.com/content/early/2021/05/18/flgastro-2020-101661.abstract N2 - 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. ER -