Acoustic Radiation Force Impulse (ARFI) Elastography in Autoimmune and Cholestatic Liver Diseases.

INTRODUCTION: Acoustic Radiation Force Impulse (ARFI) elastography evaluates hepatic fibrosis non-invasively and has been mainly validated in viral hepatitis. Data on rare liver diseases such as autoimmune hepatitis (AIH), overlap syndrome, primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) are sparse. MATERIAL AND METHODS: 85 patients (including 31 AIH, 26 PBC, 16 PSC and 3 PSC-and 9 PBC-AIH-overlap syndromes) were retrospectively analysed pointing at ARFI elastography of the liver and the correlation with histologic Ishak fibrosis score (F0-6). Results of shear wave velocities (m/s) were expressed as mean ± standard deviation. RESULTS: The mean shear wave velocity of all 85 patients showed 1.80 ± 0.84 m/s (0.74-3.98). The ARFI elastography values correlated with the degree of fibrosis in all patients overall and in patients with AIH, overlap syndrome and PSC, respectively. The subgroup of 26 patients with PBC (only with Ishak F > 3) revealed no correlation between ARFI and these early fibrosis stages (r = 0.019, p = 0.927). ARFI elastography correlated with bilirubin, AST, but not with patient age, body mass index or measurement depth. The cut-off of 2.04 m/s for detecting cirrhosis (Ishak F > 5) leads to a sensitivity of 90.0% and specificity of 74.7% (AUROC 87.2%). CONCLUSION: ARFI elastography can evaluate fibrosis in AIH, PSC and PSC-/PBC-AIH-overlap syndrome with good accuracy for the detection of hepatic cirrhosis. Shear wave velocities in PBC should be interpreted with caution in early stages of fibrosis.

Hepatopatología para gastroenterólogos y hepatólogos. Tercera parte: patología de la enfermedad hepática necroinflamatoria crónica / Hepatology for Gastroenterologists and Hematologists. Part Three: pathology of chronic necroinflammatory liver disease

En la interpretación de una biopsia hepática, las enfermedades necroinfl amatorias hepáticas están entre laspatologías halladas más a menudo, y en el estudio histopatológico es habitual enfrentarse a varias preguntasal respecto: ¿Qué es? ¿Qué tan grave es la enfermedad? ¿Qué es lo que el clínico espera? Se buscará eneste artículo dar respuesta a tales preguntas.

Necroinfl ammatory liver diseases are one of the most frequently encountered pathologies when interpreting a liver biopsy. In a histopathological study, we faced several questions including: What is it? How severe is the illness? And what does the clinician expect? This article attempts to answer these questions.

Eficacia del mofetil micofenolato en el tratamiento de la hepatitis autoinmune en pacientes resistentes o intolerantes a tratamiento convencional

Evaluar la eficacia del Mofetil Micofenolato (MMF) como opción terapéutica en pacientes con Hepatitis Autoinmune (HAI), que no responden o no toleran la prednisona y/o azatioprina. Pacientes y métodos: se evaluaron 6 pacientes con diagnóstico de HAI tipo 1, entre 36 a 61 años, quienes fueron tratados inicialmente con Azatioprina sola o combinada con esteroides sin respuesta bioquímica, o con intolerancia a estos medicamentos. Se administró 1 g B.I.D a todos los pacientes, 2 pacientes recibieron sólo MMF y 4 pacientes recibieron esteroides a dosis mínimas y MMF. Se evaluó el efecto del MMF en el valor de las enzimas hepáticas (AST y ALT), de la bilirrubina y en la concentración de inmunoglobulina G (IgG), los cuales se determinaron después del inicio del MMF cada 3 a 6 meses. Los pacientes fueron evaluados durante 27-19 meses. Resultados: los valores de AST, ALT mejoraron de 3 a 26 veces en los 6 pacientes y se normalizaron en 3 pacientes; la bilirrubina y la concentración de IgG disminuyeron de 1 a 5 veces su valor en los 6 pacientes. Conclusiones: el MMF en HAI, solo o en combinación con esteroides resulta eficaz para el control de la inflamación hepática demostrado por la mejoría de los parámetros bioquímicos y disminución de IgG, por lo que puede ser una alternativa para el tratamiento de pacientes seleccionados con HAI.

To assess the value of mycophenolate mofetil (MMF) as a therapeutic option in patients with autoimmune hepatitis (AIH), who did not respond or not tolerate prednisone and/or azathioprine. Patients and methods: Six patients with AIH were studied; age range between 36 and 61 years old, were evaluated. Initial treatment in all patients was azathioprine alone or combined with prednisone who did not demonstrate biochemical response or patients who could not tolerate this former treatment. All patients received MMF 2 g/day, 2 patients received MMF alone and 4 patients received minimal doses of steroids and MMF. Endpoints were normalization or improvement in liver function tests and immunoglobulin G (IgG) concentration. Patients were followed-up after they started treatment with MMF every 3 months during 27 μ19 months. Results: AST and ALT levels improved in 6 patients 3 to 26 times their value, and normalized in 3 patients; bilirrubin and IgG were in the normal range after treatment in all patients. Conclusions: MMF in AIH was effective and well tolerated and all patients showed improvement in liver function test (AST, ALT, and TB) and normalization of IgG. MMF seems to be an alternative treatment in selected patients with AIH.