Management of Autoimmune Hepatitis in the Elderly
Background Autoimmune hepatitis is an uncommon chronic progressive inflammatory disease of the liver, characterised by hypergammaglobulianemia, circulating autoantibodies, and interface hepatitis histologically. It is traditionally thought to be a disease of young women. However, recent epidemiological and retrospective studies suggest that it might be a disease predominantly of older women. Studies of AIH in elderly patients have been fairly limited.
Aim To investigate the differences in the clinical presentations and the management of AIH in the elderly and the younger patients.
Methods We conducted a search on MEDLINE (from 1946), PubMed (1946) and EMBASE (1949) through to November 2013 using the terms 'autoimmune hepatitis in the elderly', and the combinations of 'Autoimmune hepatitis' AND the following terms: 'elderly', 'aging', 'older patients', and 'older'. The reference lists of relevant articles were also searched for appropriate studies.
Results A total of 1063 patients were identified with AIH in 10 retrospective studies. The definition of 'elderly' ranged from 60 to 65 years; 264 elderly and 592 younger patients were included for analysis. Elderly, 24.8%, were more likely to present asymptomatically, cirrhotic at presentation and HLA-DR4-positive. They are less likely to be HLA-DR3-positive and to relapse after treatment withdrawal after complete remission.
Conclusions AIH is an important differential in elderly patients with cirrhosis or abnormal LFTs. Elderly are more likely to be cirrhotic and asymptomatic at presentation. Glucocorticoids use should be readily considered in the elderly patients as the current evidence suggests that they respond well to the therapy, with less relapse after treatment withdrawal.
Autoimmune hepatitis is an uncommon chronic progressive inflammatory disease of the liver, characterised by hypergammaglobulianemia, circulating autoantibodies and the histological change of interface hepatitis, which is responsive to immunosuppressive therapy in the majority of cases. It was first described by Waldenstrom, Kunkel and others in the early 1950s as a progressive chronic hepatitis predominantly in young women. However, recent epidemiological and retrospective studies suggest that it might be a disease predominantly of older women.
Studies of AIH in elderly patients have been fairly limited due to the traditional belief that it is a disease of young women. We conducted a literature search and meta-analysis on the topic of autoimmune hepatitis in the elderly population, to better understand the disease in this cohort of patients compared to the younger patients with autoimmune hepatitis. The aims of the literature review are to compare the differences in the presentations – clinically, biochemically, serologically and histologically, between the elderly and the younger patients; in the mode of presentation; the associated autoimmune diseases; as well as in response and tolerability to treatments. This should produce a better understanding of the disease process in the elderly and allow better management of the elderly patients who present with this condition.
Abstract and Introduction
Abstract
Background Autoimmune hepatitis is an uncommon chronic progressive inflammatory disease of the liver, characterised by hypergammaglobulianemia, circulating autoantibodies, and interface hepatitis histologically. It is traditionally thought to be a disease of young women. However, recent epidemiological and retrospective studies suggest that it might be a disease predominantly of older women. Studies of AIH in elderly patients have been fairly limited.
Aim To investigate the differences in the clinical presentations and the management of AIH in the elderly and the younger patients.
Methods We conducted a search on MEDLINE (from 1946), PubMed (1946) and EMBASE (1949) through to November 2013 using the terms 'autoimmune hepatitis in the elderly', and the combinations of 'Autoimmune hepatitis' AND the following terms: 'elderly', 'aging', 'older patients', and 'older'. The reference lists of relevant articles were also searched for appropriate studies.
Results A total of 1063 patients were identified with AIH in 10 retrospective studies. The definition of 'elderly' ranged from 60 to 65 years; 264 elderly and 592 younger patients were included for analysis. Elderly, 24.8%, were more likely to present asymptomatically, cirrhotic at presentation and HLA-DR4-positive. They are less likely to be HLA-DR3-positive and to relapse after treatment withdrawal after complete remission.
Conclusions AIH is an important differential in elderly patients with cirrhosis or abnormal LFTs. Elderly are more likely to be cirrhotic and asymptomatic at presentation. Glucocorticoids use should be readily considered in the elderly patients as the current evidence suggests that they respond well to the therapy, with less relapse after treatment withdrawal.
Introduction
Autoimmune hepatitis is an uncommon chronic progressive inflammatory disease of the liver, characterised by hypergammaglobulianemia, circulating autoantibodies and the histological change of interface hepatitis, which is responsive to immunosuppressive therapy in the majority of cases. It was first described by Waldenstrom, Kunkel and others in the early 1950s as a progressive chronic hepatitis predominantly in young women. However, recent epidemiological and retrospective studies suggest that it might be a disease predominantly of older women.
Studies of AIH in elderly patients have been fairly limited due to the traditional belief that it is a disease of young women. We conducted a literature search and meta-analysis on the topic of autoimmune hepatitis in the elderly population, to better understand the disease in this cohort of patients compared to the younger patients with autoimmune hepatitis. The aims of the literature review are to compare the differences in the presentations – clinically, biochemically, serologically and histologically, between the elderly and the younger patients; in the mode of presentation; the associated autoimmune diseases; as well as in response and tolerability to treatments. This should produce a better understanding of the disease process in the elderly and allow better management of the elderly patients who present with this condition.
SHARE
