Hepatitis

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Hepatitis for December 5, 2011 SUMMARY AND COMMENT Histologic Features Can Differentiate Drug-Induced Liver Injury from Autoimmune Hepatitis December 2, 2011 | Atif Zaman, MD, MPH | Gastroenterology Investigators report progress in using histologic data to more accurately distinguish between the two conditions. Reviewing: Suzuki A et al. Hepatology 2011 Sep 54:931 SUMMARY AND COMMENT Long-Term Morbidity and Mortality with NAFLD and Advanced Fibrosis December 2, 2011 | Atif Zaman, MD, MPH | Gastroenterology At 7 years of follow-up, about 20% of patients with NAFLD developed liver complications and 13% died or received a transplant. Adjusted outcomes were favorable compared with similar patients with HCV infection. Reviewing: Bhala N et al. Hepatology 2011 Oct 54:1208 SUMMARY AND COMMENT Perioperative Death Rate from Bariatric Surgery Is Higher with Cirrhosis Free! November 18, 2011 | Atif Zaman, MD, MPH | Gastroenterology Clinicians should assess whether patients receiving bariatric surgery for obesity have cirrhosis and, if so, possibly refer them to a high-volume center for the procedure. Reviewing: Mosko JD and Nguyen GC. Clin Gastroenterol Hepatol 2011 Oct 9:897 FEATURE HCV Treatment Studies at AASLD: Wow . . . and I Mean WOW! Free! November 14, 2011 | HIV/AIDS Clinical Care Dr. Paul Sax reviews the "breathtaking" results just presented at The Liver Meeting, in his blog HIV and ID Observations. SUMMARY AND COMMENT Emerging Treatment Options for Severe Acute Alcoholic Hepatitis November 10, 2011 | Atif Zaman, MD, MPH | Gastroenterology Adding N-acetylcysteine to glucocorticoid therapy did not improve 6-month survival. Early liver transplant did, but in a selectively chosen subgroup. Reviewing: Nguyen-Khac E et al. N Engl J Med 2011 Nov 10; 365:1781 Mathurin P et al. N Engl J Med 2011 Nov 10; 365:1790 Brown RS Jr. N Engl J Med 2011 Nov 10; 365:1836 Free Full-Text Article Summary and Comment Histologic Features Can Differentiate Drug-Induced Liver Injury from Autoimmune Hepatitis Investigators report progress in using histologic data to more accurately distinguish between the two conditions. The clinical scenario of a patient who presents with acute hepatitis on potentially hepatotoxic medications, with negative viral serologies but low-level autoimmune markers, can be challenging. The difficulty lies in determining whether the patient has drug-induced liver injury (DILI), for which there is no specific treatment, or autoimmune hepatitis (AIH), for which immunosuppressants are indicated. To date, histologic findings have generally not been helpful. To explore possible differences in histologic profiles that could improve diagnostic accuracy, four experienced hepatopathologists conducted detailed, blinded reviews of 63 liver biopsies of clinically well-characterized cases of AIH and DILI. All were reviewed from clinical and histologic standpoints to verify diagnoses. Concordance of clinical diagnosis with histologic diagnosis was 65%. However, among the four hepatopathologists, complete agreement on histologic diagnosis was only 46%. Based on statistical modeling, several histologic characteristics predicted DILI versus AIH: portal inflammation, portal plasma cells, intra-acinar lymphocytes and eosinophils, rosette formation, and canalicular cholestasis (area under the curve, 0.9). Specifically, the presence of intra-acinar lymphocytes and canalicular cholestasis favored DILI, whereas the presence of rosette formation, portal plasma cells, and severe portal inflammation favored AIH. Of note, the presence of intra-acinar eosinophils, which has been regarded as one of the histologic findings suggesting DILI, was more frequently seen in AIH in this cohort. Comment: Results should be interpreted with caution because of the small sample size, and because even experts frequently disagreed on histologic diagnosis. Nonetheless, a larger study to assess interobserver variation and cross-validate these findings should be performed. Histologic criteria such as these that reliably differentiate DILI from AIH would be extremely useful in clinical practice. — Atif Zaman, MD, MPH Published in Journal Watch Gastroenterology December 2, 2011 Citation(s): Suzuki A et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. Hepatology 2011 Sep; 54:931. Medline abstract (Free)