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Diagnosis and treatment of autoimmune hepatitis at age 65 and older
Author(s) -
Verslype C.,
George C.,
Buchel E.,
Nevens F.,
Van Steenbergen W.,
Fevery J.
Publication year - 2005
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2005.02403.x
Subject(s) - medicine , autoimmune hepatitis , gastroenterology , hepatitis , anti nuclear antibody , azathioprine , jaundice , prednisone , ascites , liver biopsy , immunology , biopsy , antibody , disease , autoantibody
Summary Aim: To study features in older patients with autoimmune hepatitis, as this was considered mainly a disease of young females. Methods: Analysis of 28 patients diagnosed at age ≥65 years compared with 84 younger patients. Results: The incidence was similar at all age decades. The ratio M:F was 1 : 3 (≥65 years) vs. 1 : 2 (<65 years). Presenting symptoms were not different when compared with younger patients and consisted of general malaise and fatigue (36%), jaundice ± other symptoms (50%), or ascites (11%). Antinuclear antibodies (ANA) ≥ 1/80 were positive in 93%, smooth muscle antibodies (SMA) > 1/40 in 50%, anti‐liver kidney microsomes (anti‐LKM) proved always negative. Histology showed acute necrotizing hepatitis in 19%, severe interphase hepatitis in 15%, chronic hepatitis with plasmo‐lymphocytic infiltrate in 30%, cirrhosis in 29% (with active inflammation in one‐third); biopsy was refused in 11%. The elderly responded very well to low doses of methylprednisolone (≤8 mg) and azathioprine (1 mg/kg). This schedule obviates side‐effects such as infections seen with higher dosages. Conclusion: Autoimmune hepatitis has to be also looked for in the elderly with acute and chronic hepatitis. The steroid therapy should be individualized but kept at a low dose.