Autoimmune Hepatitis Overlap Syndromes and Liver Pathology

Gastroenterol Clin North Am. 2017 Jun;46(2):345-364. doi: 10.1016/j.gtc.2017.01.008.

Abstract

Autoimmune hepatitis (AIH) may have an atypical serum alkaline phosphatase elevation, antimitochondrial antibodies, histologic features of bile duct injury/loss, or cholangiographic findings of focal biliary strictures and dilations. These manifestations characterize the overlap syndromes. Patients can be classified as having AIH with features of primary biliary cholangitis, primary sclerosing cholangitis, or a cholestatic syndrome. The gold standard of diagnosis is clinical judgment. Histologic evaluation is a major diagnostic component. Treatment is based on algorithms; outcomes vary depending on the predominant disease component. Combination therapy has been the principal recommendation.

Keywords: Autoimmune hepatitis; Cholestatic; Histologic findings; Overlap; Variants.

Publication types

  • Review

MeSH terms

  • Alkaline Phosphatase / blood
  • Antibodies / blood
  • Bile Ducts / pathology
  • Cholangitis / blood
  • Cholangitis / diagnosis*
  • Cholangitis / drug therapy
  • Cholangitis / pathology*
  • Cholestasis / blood
  • Cholestasis / diagnosis*
  • Cholestasis / drug therapy
  • Cholestasis / pathology*
  • Endoscopy, Digestive System
  • Hepatitis, Autoimmune / blood
  • Hepatitis, Autoimmune / diagnosis*
  • Hepatitis, Autoimmune / drug therapy
  • Hepatitis, Autoimmune / pathology*
  • Humans
  • Liver / pathology
  • Magnetic Resonance Imaging
  • Mitochondria / immunology
  • Syndrome
  • gamma-Glutamyltransferase / blood

Substances

  • Antibodies
  • gamma-Glutamyltransferase
  • Alkaline Phosphatase