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Autoimmune serology testing in clinical practice: An updated roadmap for the diagnosis of autoimmune hepatitis
The diagnosis of autoimmune hepatitis (AIH) is based on a combination of clinical, laboratory and histological findings in patients with unexplained acute or chronic hepatitis [1–3]. The disease is considered rare but recent population-based studies from England and New Zealand have shown that AIH incidence is on the rise [4,5]. As in most autoimmune diseases, AIH is characterized by female predominance while every subject can be affected irrespective of age, gender, and ethnicity [6,7]. Differential diagnosis includes viral, toxic, genetic, and metabolic liver diseases [1–3,6].NAFLD and autoimmune hepatitis: Do not judge a book by its cover
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and is defined by the accumulation of fat in > 5% of hepatocytes at the histological level or by proton magnetic resonance spectroscopy (1H-MRS) in association with insulin resistance in patients who are not alcohol consumers (< 20–30 g/day or < 21 standard drinks/week for men and < 10–20 g/day or < 14 standard drinks/week for women) [1,2]. This disease, largely unknown few decades ago, affects almost a quarter of adults worldwide ranging from 13.5% in Africa to approximately one third in the Middle East and South America [1–3] and therefore, it is now considered the commonest chronic liver disease.Extrahepatic autoimmunity in autoimmune liver disease
The most important autoimmune liver disease include: autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis. In general, about one in three patients with an autoimmune liver disease have a concomitant extrahepatic autoimmune disease, which may include rheumatological, endocrinological, gastrointestinal, pulmonary or dermatological conditions. The pathogenesis of these conditions includes the production of both innate and adaptive immune responses targeting cholangiocytes as well as different extrahepatic tissues.
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