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BMC Gastroenterology

, 5:27

First Online: 15 August 2005Received: 30 December 2004Accepted: 15 August 2005


BackgroundAutoimmune hepatitis AIH has been reported to show considerable geographical variation in frequency and clinical manifestations. It is considered a rare cause of liver disease in India. The present study was undertaken to determine the incidence, clinical, biochemical and histological profile of AIH in this part of the world.

MethodsPatients presenting with acute or chronic liver disease between January 1999 and June 2002 were evaluated prospectively. AIH was diagnosed using the international autoimmune hepatitis group criteria. Workup included clinical, biochemical, USG, viral markers, UGI endoscopy, AI markers ANA, SMA, Anti-LKM, AMA, RF, p-ANCA using indirect immunofluorescence and liver biopsy if possible.

ResultsForty-one of 2401 1.70% patients were diagnosed to have autoimmune liver disease. Out of these, 38 had autoimmune hepatitis and the rest 3 had primary biliary cirrhosis. The mean age of the patients of autoimmune hepatitis was 36.2 15.9 years, 34 89.4% were females, and the duration of symptoms was 20.3 20.5 months. Nineteen 50% of them presented with chronic hepatitis, 13 34.2% as cirrhosis, 5 13.1% with acute hepatitis and 1 2.6% with cholestatic hepatitis. The presentations were jaundice in 21 55.2%, pedal edema and hepatomegaly in 17 44.7%, splenomegaly in 13 34.2%, encephalopathy, abdominal pain in 9 23.6% and fever in 8 21%. Twelve had esophageal varices and 3 had bled. Biochemical parameters were ALT 187 360 U-L, AST 157 193 U-L, ALP 246 254 U-L, globulin 4.1 1.6 g-dL, albumin 2.8 0.9 g-dL, bilirubin 5.2 7.4 mg-dL, prothrombin time 17 7 sec and ESR 47 17 sec. The autoimmune markers were SMA 24, ANA 15, both SMA and ANA 4, AMA 1, rheumatoid factor 2, pANCA 1, and Anti-LKM in none. Thirty 79% patients had definite AIH and eight 21% had probable AI hepatitis. Associated autoimmune diseases was seen in 15-38 39.4%, diabetes 4, hypothyroidism 3, vitiligo 2, thrombocytopenia 2, rheumatoid arthritis 2, Sjogren-s syndrome 1 and autoimmune polyglandular syndrome III in 1. Viral markers were positive in two patients, one presenting as acute hepatitis and HEV-IgM positive and another anti-HCV positive.

ConclusionIn India, autoimmune hepatitis is uncommon and usually presents with chronic hepatitis or cirrhosis, acute hepatitis being less common. Age at presentation was earlier but clinical parameters and associated autoimmune diseases were similar to that reported from the west. Primary biliary cirrhosis is rare. Type II AIH was not observed.

AbbreviationsANAanti-neutrophilic antibody

AMAanti-mitochondrial antibody

Anti-LKManti-liver-kidney microsomal antibodies

p-ANCAanti-neutrophil cytoplasmic antibody

RFrheumatoid factor

PBCprimary biliary cirrhosis

PSCprimary sclerosing cholangitis

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-5-27 contains supplementary material, which is available to authorized users.

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Autor: Gourdas Choudhuri - Sanjay K Somani - Chalamalasetty S Baba - George Alexander


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