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Medicine (Baltimore). 2017 Aug;96(34):e7708. doi: 10.1097/MD.0000000000007708.

Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: A cohort study.

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aDepartment of Public Health and Clinical Medicine bDepartment of Medical Biosciences, Pathology, Umeå University, Umeå cDepartment of Gastroenterology and Hepatology, Department of Medical and Health Sciences, Linköping University, Linköping dDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg eDepartment of Medicine, Section of Hepatology and Gastroenterology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm fDepartment of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala gDivision of Infectious Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm hGastroenterology Division, Department of Clinical Sciences, Lund University, University Hospital Skane iDepartment of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.


Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis.A total of 258 liver biopsies from 101 patients (72 women, 29 men) were analyzed by a single pathologist and classified according to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased, or stable), and groups were compared.Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in the fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only 5 patients at the last biopsy.Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

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