XML Feed for RxPG News   Add RxPG News Headlines to My Yahoo!   Javascript Syndication for RxPG News

Research Health World General
 Latest Research
 Infectious Diseases
 Respiratory Medicine
 Public Health
 Clinical Trials
 Medical News
 Awards & Prizes
 Special Topics
 Odd Medical News
 World News

Last Updated: Aug 19th, 2006 - 22:18:38

Hepatitis Channel
subscribe to Hepatitis newsletter

Latest Research : Gastroenterology : Liver : Hepatitis

   DISCUSS   |   EMAIL   |   PRINT
Therapy may not be necessary for asymptomatic autoimmune hepatitis
Aug 15, 2005, 21:08, Reviewed by: Dr.

"Our data suggest that it may be safe to follow asymptomatic patients with a strategy to institute immunosuppressive treatment if symptoms develop over time"

It is not uncommon for patients with autoimmune hepatitis (AIH), a disease in which the patient's own immune system attacks the liver, to have no symptoms. Such cases are being diagnosed more frequently due to the increased practice of administering routine liver enzyme and antibody tests. Whether or not to treat asymptomatic AIH remains unclear--therapy with immunosuppressants could potentially slow progress of the disease but involves side effects that are sometimes toxic.

In order to determine if immunosuppressive therapy is indicated when no symptoms are present, researchers led by Jordan J. Feld, M.D. of the Departments of Medicine and Pathology at the University Health Network of the University of Toronto, compared the natural course of asymptomatic AIH with symptomatic AIH.

The study included 124 patients diagnosed with AIH at the Toronto Western Hospital Liver Clinic between 1970 and 2002 – 31 of whom were asymptomatic. Researchers reviewed the patients' clinical records to document the presence or absence of symptoms. Patients were considered asymptomatic if they were free of all symptoms, even non-specific ones such as fatigue or abdominal pain. Immunosuppressive therapy was recommended for all symptomatic patients, while asymptomatic patients were not treated, unless treatment had already been initiated. Patients who developed symptoms during the study period were started on immunosuppressive therapy. If they remained in remission for two years with no relapse the therapy was discontinued, but it was restarted if the disease recurred off treatment.

The results of the study indicated that asymptomatic patients had lower liver enzyme and IgG antibody levels, as well as lower scores on the hepatic activity index (HAI), which measures liver inflammation, but otherwise did not differ from patients with symptoms. Half of the asymptomatic patients ended up receiving treatment either because it was already started by their physicians or because they eventually developed symptoms. "Our data suggest that it may be safe to follow asymptomatic patients with a strategy to institute immunosuppressive treatment if symptoms develop over time," the authors state, although they note that patients with no symptoms were less likely to respond to treatment than those that had symptoms.

Notably, the current study also showed that patients who had cirrhosis when diagnosed had a worse outcome than those that did not, with a higher incidence of complications or death. Treatment is normally initiated in asymptomatic patients because it is thought to prevent the development of cirrhosis, but whether this is the case remains unclear. Other studies have been inconclusive in this area and based on the current study the authors conclude: "Most [asymptomatic] patients will not develop symptoms during follow-up and they appear to do well without immunosuppressive therapy at least for as long as they remain asymptomatic."

Although the authors note that the results should be considered with caution due to the limited number of patients who underwent liver biopsy, they conclude that severe OSA, independent of being overweight, is a risk factor for liver disease. In addition, they postulate that OSA may contribute to insulin resistance and fatty liver disease, since insulin responsiveness improves after treating OSA. They suggest that the striking relationship between the severity of sleep apnea and liver damage indicates that OSA may play a role in how fatty liver disease develops.

“In conclusion,” the authors state, “OSA is a risk factor for abnormal liver enzymes independently from BMI, and should be investigated in patients without other cause of liver disease.” They conclude: “Further studies are needed to assess the prevalence of OSA in patients with NASH [nonalcoholic steatohepatitis, or fatty liver disease with inflammation] and to evaluate whether treatment of OSA may improve liver injury.”

- The results of the study appear in the July 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc. Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

Article: "Autoimmune Hepatitis: Effect of Symptoms and Cirrhosis on Natural History and Outcome," Jordan J. Feld, Huong Dinh, Tamara Arenovich, Victoria A. Marcus, Ian R. Wanless, E. Jenny Heathcote, Hepatology; July 2005; Published Online: June 13, 2005 (DOI: 10.1002/hep.20732).

Subscribe to Hepatitis Newsletter
E-mail Address:


For generations, AASLD has been a catalyst for the investigation and treatment of liver diseases. AASLD upholds the standards of the profession and fosters research that generates improved treatment options for the millions of patients with liver disease.

As the leading organization focused solely on advancing the science and practice of hepatology, AASLD offers scientific educational symposia developed by leading hepatologists. Each event offers Continuing Medical Education (CME) and features expert speakers presenting the finest data in the most current and critical topics of liver disease. Only AASLD events meet the increasing demand of hepatology's growing importance as a medical specialty by providing participants the opportunity to exchange research, discuss outcomes, and interact with colleagues focused on liver and biliary diseases.

Related Hepatitis News

Chronic hepatitis in pediatric liver transplant patients
Vaccinating Infants of Hepatitis B Mothers Prevents Infection - Systematic Review
Need for treatment modification in older hepatitis C patients
Therapy may not be necessary for asymptomatic autoimmune hepatitis
PegInterferon-alfa-2b with Ribavirin Shows Promise

For any corrections of factual information, to contact the editors or to send any medical news or health news press releases, use feedback form

Top of Page


© Copyright 2004 onwards by RxPG Medical Solutions Private Limited
Contact Us