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News

Clinical manifestations and management of autoimmune hepatitis in the elderly

January's issue of the Alimentary Pharmacology & Therapeutics evaluates the management of autoimmune hepatitis in the elderly.

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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.

Professor Eslick and colleagues from Australia investigated the differences in the clinical presentations and the management of AIH in the elderly and the younger patients.

The researchers conducted a search on MEDLINE (from 1946), PubMed (1946) and EMBASE (1949) through to 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.

Elderly were more likely to present as HLA-DR4-positive
Alimentary Pharmacology & Therapeutics

The research team identified a total of 1063 patients with AIH in 10 retrospective studies.

The definition of ‘elderly’ ranged from 60 to 65 years.

The research team included 264 elderly and 592 younger patients for analysis.
 
The team noted that elderly 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.

Professor Eslick's team comments, "uAIH 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."

Alimentary Pharmacol Ther 2014: 39(2): 117-124
19 December 2013

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