GASTROENTEROLOGY ARTICLE OF THE WEEK
October 27, 2011
Lohse AW, Mieli-Vergani G. Autoimmune hepatitis. J Hepatol 2011;55:171-182
1. Emperipolesis is
a. A city in Alabama
b. A term referring to the Roman Empire
c. Necrosis of liver cells around the portal triads
d. Arrangement of liver cells in gland-shaped structures
e. Penetration of inflammatory cells inside the liver cells
f. A characteristic finding in AIH biopsies
2. Endpoints of therapy for AIH should be
a. Decrease of ALT and AST to <2x ULN
b. Normalization of ALT regardless of IgG levels
c. Normalization of ALT and IgG levels
d. Normalization of IgG levels, even if ALT is slightly elevated
True or False
3. A diagnosis of autoimmune hepatitis requires a liver biopsy
4. Soluble Liver Antibody (SLA) is the only disease-specific auto-antibody available in clinical practice
5. Patients with severe, icteric fulminant presentation of AIH should be treated initially with prednisone/azathioprine combination therapy for faster results
6. In a patient with an acute icteric presentation of AIH, if the diagnosis is not made, the patient is unlikely to improve
7. 5% to 10% of patients with active AIH have normal IgG levels
8. MMF is an attractive alternative for patients intolerant to azathioprine, but not very effective for those who are refractory to azathioprine
9. Cirrhosis in AIH is often macronodular, needle biopsy may miss the presence of cirrhosis
10. Severe acute fulminant AIH may present with normal IgG and negative autoimmune markers, liver biopsy may show centrilobular necrosis instead of the usual periportal necrosis pattern
11. Budesonide is an effective alternative to prednisone for patients with AIH and cirrhosis
12. After transplantation, recurrence of AIH is rare, as these patients are maintained on immunosupresants