Title page for ETD etd-01102011-172208

Document Type Master's Dissertation
Author Buchel, Elwin Herbert
URN etd-01102011-172208
Document Title Autoimmune hepatitis : a clinical study
Degree MD
Department Internal Medicine
Advisor Name Title
Prof J Fevery Co-Supervisor
Prof A L van Gelder Supervisor
  • AIH
  • autoimmune hepatitis
Date 2007-08-03
Availability unrestricted
This study involved the analysis of 112 patients with autoimmune hepatitis (AIH), during which process several specific issues or problems were identified. One subgroup included pregnant patients, and another patients diagnosed at an older age (>65 years). The diagnosis of AIH is not always easy, and the investigations revealed that some patients diagnosed with AIH had features of an overlap syndrome (with primary sclerosing cholangitis) or in fact never had AIH, but as retrospectively diagnosed, had toxic hepatitis masquerading as AIH. Some patients who were initially documented as clearly having chronic hepatitis C, also had autoantibodies in their serum and were (or could have been) incorrectly diagnosed as AIH. The results showed a large variability in symptoms and complaints at the time of diagnosis of AIH. The disorder can present as an acute or chronic disease. In some patients only vague symptoms are reported and in others, the diagnosis is an incidental discovery because of abnormal liver enzymes. In contrast, other patients present with acute liver failure. The diagnosis must be considered in patients with non-viral liver disease with significantly raised ANA and SMA and high serum gammaglobulin concentrations. No fixed age predisposition was found, but rather an even spread over various age groups. The male:female ratio is 1:2.5. This disorder can for the most part be well treated with a combination therapy of corticosteroids and azathioprine. Experience shows that high doses of corticosteroids can cause serious complications, particularly in older patients. A lower dose is mostly adequate, although biochemical normalisation may take longer. In approximately half of the patients, corticosteroid-therapy was discontinued, with azathioprine as the only treatment. The long-term survival of adequately treated patients is almost equal to that of the control group. In the cohort, ten patients died: three who had presented with acute liver failure, two who later developed a hepatocellular carcinoma and one who died because of cerebral lymphoma. Three older patients died of sepsis, possibly co-induced by high doses of steroids. Five patients underwent liver transplantation, of which one died of aspergillosis.

2007 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria

Please cite as follows:

Buchel, EH 2007, Autoimmune hepatitis : a clinical study, MD dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-01102011-17220/ >


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