Review of Autoimmune Hepatitis: Diagnosis and Treatment

Background: Autoimmune hepatitis (AIH) is a hepatocyte injury characterized by a dis-regulated immune system, inflammation of the liver with interface hepatitis, serum antibodies and elevated gamma-globulins. Currently, it exists 2 mainly types on autoimmune hepatitis, based on the presentation of their autoantibodies: type 1 and 2. Type 1 is the one of interest in this review. Autoimmune hepatitis type 1 is an indolent inflammatory disease mediated by abnormal autoimmune reaction, commonly seeing in women (4:1), with no preference of age, however typically present in 4th and 6th decade’s individuals, and a good response to immunosuppressive therapy. Autoimmune hepatitis is known to present not specific symptoms which can go from inexistent to fulminant or exacerbate presentation. The incidence of autoimmune hepatitis in western country is 1/5000 - 1/10,000. Although the detection rate of AIH increasing, especially in China, autoimmune hepatitis diagnosis and treatment remain challenging. Most AIH case do not present pathognomonic biomarkers, however the diagnostic has to considerate other features, which had been codified into validated diagnosis scoring systems. Regarding the treatment, based on prior literature autoimmune hepatitis is mostly sensitive to prednisone or azathioprine, however the use of other immunosuppressive agent or event their combination had offer distinct advantages. Autoimmune hepatitis presents a great life threatening disorder especially because of the delay in the early stage on the disease, the not specific presentations, and the large overlap syndrome associate with it. A deep knowledge in its identification, specific diagnostic criteria, and its therapeutic strategy is much needed. Conclusion: Autoimmune hepatitis is a systemic disease that is difficult to recognize because of its variable clinical presentation and histological features that are not strictly specific. Several new autoantibodies as well as recently simplified diagnostic criteria may allow the primary care physician to progress in the diagnostic process. This is all the more important as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis and immunosuppressive treatment leads to remission in a large majority of cases.