Silfhout, J.J. van (2014) Clinic and treatment of autoimmune hepatitis and overlap syndromes in the elderly compared to younger patients. thesis, Medicine.
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Abstract
Objective: Autoimmune hepatitis (AIH) and AIH-overlap syndromes are uncommon chronic inflammatory liver diseases of unknown origin. AIH is characterised by hypergammaglobulinemia, circulating autoantibodies and interface hepatitis on liver biopsy. The AIH-overlap syndromes have in addition to forementioned characteristics also characteristics of cholestatic liver disease. If left untreated these diseases can lead to cirrhosis and hepatic failure. Paucity of data exists on differences associated with age in adults at presentation in clinical and laboratory features and treatment and outcome of these diseases. The aim of this study was to investigate whether there are any differences associated with age at presentation (under 60 years versus above 60 years of age) in laboratory features, clinical course and treatment outcome of adult patients with AIH en AIH-overlap syndromes. Methods: All adult patients with probable and definite AIH were retrospectively identified from four academic centres in The Netherlands participating in the Dutch Autoimmune Hepatitis Group. Those patients presenting at or above the age of 60 years (the elderly group) were compared with patients presenting at an age below 60 years (the younger group). The same was done for all patients identified with an AIH-overlap syndrome. Primary endpoints were defined as complete response after initiation of treatment and liver transplantation or liver related death. Secondary endpoints were defined as biochemical and serological differences at presentation, symptoms at presentation, mode of presentation, concurrent autoimmune diseases, differences in initial and maintenance therapy regimens, number of switches of therapy, adverse effects of therapy, achievement of remission, episodes of loss of remission, number of relapses, cirrhosis at presentation and progression of cirrhosis. Results: AIH: 367 patients were included, 73 in the elderly group, 294 in the younger group. The young group presented with significantly higher serum alanine aminotransaminase (p<0.001), presented more frequently with an acute onset of the disease (p=0.012), or with symptoms of jaundice (p=0.008) and experienced a higher frequency of relapses in a single patient compared to elderly patients. Elderly patients were significantly more likely to present with another autoimmune disease (p=0.032) and to develop type 2 diabetes after corticosteroid treatment (p<0.001). There were no other significant differences. AIH-overlap syndromes: 91 patients were included, 14 in the elderly group and 77 in the younger group. Again, the younger group presented with significantly higher serum alanine aminotransaminase (p=0.018), however no other significant differences at presentation or outcome could be found. Conclusions: Initial presentation of AIH is above the age of 60 in 20% of patients. Younger patients are more likely to have an acute onset of disease and more relapses, whereas elderly patients tend to present more asymptomatically with more concomitant autoimmune disease and elderly patients develop more type 2 diabetes with glucocorticoid therapy. Therefore more awareness should be created to diagnose the disease at early onset in elderly patients and to prevent diabetes in this group. Overall, young and elderly patients respond well to treatment and have an excellent prognosis.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Alleman, Dr. M.A. and internist Isala klinieken te Zwolle |
| Supervisor name: | Hoek, Prof. Dr. B. van and Leids Universitair Medisch Centrum and Afdeling maag-, darm- en leverziekten |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/87 |
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