British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis

Abstract

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease which, if untreated, often leads to cirrhosis, liver failure and death. The last British Society of Gastroenterology (BSG) guideline for the management of AIH was published in 2011. Since then, our understanding of AIH has advanced in many areas. This update to the previous guideline was commissioned by the BSG and developed by a multidisciplinary group. The aim of this guideline is to review and summarise the current evidence, in order to inform and guide diagnosis and management of patients with AIH and its variant syndromes. The main focus is on AIH in adults, but the guidelines should also be relevant to older children and adolescents.

Keywords: autoimmune hepatitis; autoimmune liver disease; drug toxicity; liver.

Figure 1. Overview of pathogenesis. Initial hepatocytes injury (acute hepatitis) is initiated by innate immune cells. Subsequently, cytokines and chemokines released from innate cells and injured hepatocytes, recruit adaptive CD4 T cell subsets (effector T helper type 1, Th1 and type 17, Th17 and regulatory T cells) and B cells to the site of lobular and interface hepatitis. T cells require interleukin 2 for their function and survival. Antigen presenting dendritic cells and B cells interact with T cells. Antigen-exposed B cells then become plasma cells and secrete immunoglobulin G.

Figure 2. Overview of initial treatment of autoimmune hepatitis. AEs, adverse events; ALT, aanine transaminae; AST, aspartate transaminase; TPMT, thiopurine methyltransferase.

Figure 3. Summary of suggested bone health strategy for patients on steroids.