Review article: autoimmune hepatitis -- current management and challenges

Area of Science:

• Hepatology
• Immunology
• Internal Medicine

Background:

• Autoimmune hepatitis (AIH) is an idiopathic liver disease characterized by interface hepatitis, elevated immunoglobulins, autoantibodies, and responsiveness to immunosuppression.
• AIH affects all demographics globally, presenting with diverse clinical manifestations from asymptomatic to acute liver failure.

Purpose of the Study:

• To review recent advancements in the understanding of autoimmune hepatitis (AIH) pathogenesis.
• To summarize current knowledge on clinical, serological, and histological features of AIH.
• To evaluate diagnostic criteria and evolving treatment strategies for AIH.

Main Methods:

• A comprehensive literature review was conducted.
• Studies were primarily extracted from PubMed.
• The review focused on publications from the last 15 years.

Main Results:

• Autoimmune hepatitis (AIH) exhibits global distribution across all ages, sexes, and ethnicities.
• Clinical presentations vary widely, and while hypergammaglobulinaemia is typical, normal IgG levels occur in a subset of patients.
• Liver histology and autoantibodies are key diagnostic indicators, though not pathognomonic.

Conclusions:

• Autoimmune hepatitis (AIH) presents significant diagnostic and therapeutic challenges.
• Familiarity with diverse disease expressions, histology, and serology is crucial for clinicians, pathologists, and lab personnel.
• Conventional immunosuppression shows limitations in achieving optimal treatment response, highlighting the need for individualized management and novel therapeutic agents.