Autoimmune hepatitis: an approach to disease understanding and management

INTRODUCTION: Autoimmune hepatitis is a chronic immune-mediated liver injury, frequently associated with progression to end-stage liver disease if untreated. Patients commonly present with hepatitis, positive immune serology, elevated immunoglobulins and compatible liver histology, in the absence of an alternative aetiology. SOURCES OF DATA: Data for this review were obtained using PubMed. AREAS OF AGREEMENT: Disease usually responds to steroids and azathioprine, and appears to be a manifestation of autoimmune predisposition triggered in genetically susceptible individuals exposed to likely environmental challenges. We provide an up-to-date approach to disease understanding and management along with the clinical approach to diagnosis and current treatment suggestions. AREAS OF CONTROVERSY: Controversies such as second line therapies and novel markers of disease activity are introduced. GROWING POINTS: Increased understanding of the immunoregulatory mechanisms behind autoimmune hepatitis has led to opportunities for new therapies. These are developed including a discussion of timely research studies relevant to future therapies for patients.