Original article—liver, pancreas, and biliary tractPatients With Typical Laboratory Features of Autoimmune Hepatitis Rarely Need a Liver Biopsy for Diagnosis
Section snippets
Patients and Methods
A search was performed in the diagnoses medical index at the Mayo Clinic (Rochester, MN) for AIH from 1997 to 2007. The search was based on the presence of AIH in the text and the search retrieved all patients who had AIH mentioned in the medical charts, such as the primary diagnosis, differential diagnosis, family history of AIH, and liver transplantation for AIH. We identified 1532 patients. Only patients with available clinical and biochemical components of the new simplified criteria at
General Characteristics of the Patients
A total of 257 well-characterized AIH patients were identified with available clinical, laboratory, and histologic data required for diagnosis according to the new simplified criteria. Overall, 560 patients were excluded owing to an earlier diagnosis of AIH outside the Mayo Clinic and already were started on treatment when first seen at the Mayo Clinic. There were 125 who had decompensated liver disease at presentation or had undergone transplantation for AIH (n = 70). There were 57 patients
Discussion
Our study indicates that the vast majority of patients with typical laboratory features of AIH are likely to have compatible liver histology. Among patients with a clinical diagnosis of AIH, very few have atypical histology yet the presence of atypical histology may have very little impact on patient management. Posttreatment liver biopsy does not seem to impact clinical decision making. Furthermore, the presence of mild interface hepatitis did not predict a relapse.
As pointed out in a recent
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2022, Journal of HepatologyCitation Excerpt :The role of liver biopsies is also not entirely certain in AIH. Biopsies are often used in the diagnosis of AIH but most patients with clinical and laboratory features of AIH were found to have a compatible liver histology, and clinical management was not changed due to atypical histology as most patients were treated with immunosuppressive agents.25 HLA genotypes have been suggested as potential biomarkers to aid in the clinical diagnosis of DILI.
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2016, PathologyCitation Excerpt :Several publications have challenged the significance of performing liver biopsy in AIH patients. A retrospective study evaluating 257 AIH patients reported that the vast majority of patients with typical laboratory features of AIH were likely to have compatible histological findings in the biopsy and a few cases with atypical histological findings did not have a significant impact on patient management.6 Another study of 82 AIH patients showed that normalisation of serum parameters [alanine aminotransferase (ALT) and IgG] was associated with patients who were at low risk of fibrosis progression despite the fact that laboratory indices were not reliable to predict complete histological remission.7
Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management
2015, Clinical Gastroenterology and HepatologyCitation Excerpt :Central zonal necrosis and/or perivenulitis of the central veins (Figure 2) is another feature of acute and chronic AIH and may occur in the absence of interface hepatitis.48,49 The need for a liver biopsy to diagnose AIH has been challenged.50 However, SDC scores were probable in 77% and nondiagnostic in 22% diagnosed without liver biopsy.
Conflicts of interest The authors disclose no conflicts.
Funding Professor Einar Björnsson received financial support from the Swedish Medical Research Council during his stay at the Mayo Clinic from 2008 to 2009.