Autoimmune Hepatitis: Evaluation of Clinical Presentation, Diagnosis and Response to Treatment in Iraqi Patients

Abstract

Introduction: Autoimmune hepatitis (AIH) is a chronic heterogeneous inflammatory disease of the liver activated by unknown triggers. The details of its pathogenesis remain unclear. Sufficient data on AIH in terms of epidemiology as well as disease phenotype amongst the Iraqi population is not available. Objectives: To evaluate and document the experience of Iraqi AIH patients with respect to clinical presentation, diagnosis, treatment and response to treatment in accordance with the IAIHG guidelines. Method: A prospective study was conducted on patients who attended the Gastroenterology Hepatology Teaching Hospital in Baghdad, Iraq. After examination, many biochemical and pathological parameters were analysed. Liver biopsy, abdominal ultrasound, and upper endoscopy were done. Results: Among the 70 respondents, jaundice, fatigue, arthralgia, and itching were the major symptoms recorded at presentation. Immunologic findings were positive for ANA (31 patients) and ASMA (25 patients) while hypergammaglobulinemia was recorded in 97% of all patients. Pre-treatment scoring revealed 56 definite and 14 probable AIH patients while post-treatment scoring yielded 13 definite and 23 probable AIH patients. Response to treatment showed 6 patients as non-responders, 34 patients (49%) exhibited complete response while 30 patients (43%) had a partial response. Conclusions: Iraqi patients with AIH presented late at the advanced stage of the disease with a majority having hypergammaglobulinemia which forms a solid base for disease suspicion. It is recommended that a complementary study with a larger sample size, longer follow-up duration and inclusion of cases of idiopathic hepatitis is needed.