Autoimmune hepatitis: An approach to disease understanding and management

Abstract

Introduction: Autoimmune hepatitis is a chronic immune-mediated liver injury, frequently associated with progression to end-stage liver disease if untreated. Patients commonly present with hepatitis, positive immune serology, elevated immunoglobulins and compatible liver histology, in the absence of an alternative aetiology. Sources of data: Data for this review were obtained using PubMed. Areas of agreement: Disease usually responds to steroids and azathioprine, and appears to be a manifestation of autoimmune predisposition triggered in genetically susceptible individuals exposed to likely environmental challenges. We provide an up-to-date approach to disease understanding and management along with the clinical approach to diagnosis and current treatment suggestions. Areas of controversy: Controversies such as second line therapies and novel markers of disease activity are introduced. Growing points: Increased understanding of the immunoregulatorymechanisms behind autoimmune hepatitis has led to opportunities for new therapies. These are developed including a discussion of timely research studies relevant to future therapies for patients.