Autoimmune Hepatitis-Profile and Response to Treatment in Indian Patients

Authors: Mathew P*, Kanni PY, Gowda M, Uppalapati S, Garg A, Ansari J and Praveen Kumar AC

DOI: 10.23880/ghij-16000159

Volume 4, Issue 2

Abstract

Introduction: Autoimmune hepatitis (AIH) can have varied manifestations, commonest presentation being as chronic liver disease. The data on the disease profile in India is scanty compared to the West. Aim: To study the clinical, biochemical, histological profile and response to treatment in patients with Auto-immune Hepatitis in Indian population. Methods: This is a Retrospective analysis of the twenty one (12 M = 57.1%; 9 F = 42.9%) patients diagnosed with AIH according to simplified criteria for diagnosis of AIH, in the last three years (2017-2019) in the department of medical gastroenterology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India. Results: AIH accounted for 4.3% of all the liver diseases diagnosed during the last three years. Incidence of AIH was higher in males (12 M = 57.1%; 9 F = 42.9%; male to female ratio was 1.3:1), most common presenting symptom was jaundice, sixteen (57.1%), followed by ascites seven (33%) patients. Extra-hepatic manifestation was seen in fourteen (66.7%) patients. Eleven (52.3%) patients had cirrhosis with four (19%) patients having compensated cirrhosis, five (23.8%) patients having de-compensated cirrhosis, two (9.5%) patients presenting with features of acute on chronic liver failure, two (9.5%) patients presenting with acute hepatitis and seven (33.3%) patients presenting with features of chronic hepatitis. Nineteen (91%) patients had Type I AIH, one (4.5%) patient had Type II AIH and 1 patient had seronegative AIH. Oral budesonide was started in 11(52%) of patients, 8(38%) were started on oral prednisolone and 2(10%) patients were started on intravenous methyl prednisolone in view of severe auto-immune hepatitis. Azathioprine was added in 19 patients and dose was modified according to the clinical response and side effects. Four (21.05%) patients developed drug intolerance, out of which one patient had severe adverse effect in the form of acute pancreatitis secondary to Azathioprine. Mycophenolate Mofetil (MMF) was given with good response. Mortality was noted in two (9.52%) patients. Research Conclusion: Type I AIH was the most common type of AIH and majority of the patients presented with chronic liver disease. Majority of the patients had good resolution of the disease with Azathioprine and steroids. Therapy related complications occurred in one fifths of our patients.

Keywords: AIH-Auto Immune Hepatitis; Azathioprine; Chronic Liver Disease; Auto Antibodies

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