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. 2021 May 18;13(2):126-132.
doi: 10.1136/flgastro-2020-101661. eCollection 2022.

Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH)

Victoria Mary Gordon  1 , Ratul Adhikary  2 , Guruprasad P Aithal  3 , Victoria Appleby  4 , Debasish Das  5 , James Day  6 , Toby Delahooke  7 , Selena Dixon  8 , David Elphick  9 , Claire Hardie  10 , Michael Heneghan  11 , Barbara Hoeroldt  12 , Patricia Hooper  13 , John Hutchinson  14 , Rebecca L Jones  15 , Faisal Khan  16 , Jane Metcalf  17 , Alick Nkhoma  18 , Stavroula Pelitari  19 , Martin Prince  20 , Annell Prosser  21 , Sushma Saksena  22 , Vinay Sathyanarayana  23 , Deven Vani  24 , Andrew Yeoman  25 , Dermot Gleeson  26
Affiliations

Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH)

Victoria Mary Gordon et al. Frontline Gastroenterol. .

Abstract

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.

Keywords: audit; autoimmune hepatitis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Staffing: number of hepatologists. (B) Staffing: specialist nurse provision. AIH, autoimmune hepatis; DGH, district general hospital.
Figure 2
Figure 2
(A) Treatment standards: reasons why patients were not treated within 4 months of presenting symptoms, (B) treatment standards: reasons why prednisolone stopped before 1 year. *Patient wishes or obesity, ~clinician determined.
See this image and copyright information in PMC

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