Diagnostic Criteria and Treatment Options for Autoimmune Hepatitis

Diagnostic Criteria

The American Association for the Study of Liver Diseases recommends that autoimmune hepatitis (AIH) diagnosis requires a combination of serological, biochemical, and histological findings, along with exclusion of other liver diseases, while treatment should be offered to all patients with moderate to severe disease to improve survival outcomes 1, 2
The European Association for the Study of the Liver states that AIH is characterized by hypergammaglobulinemia/elevated serum IgG, circulating autoantibodies, and interface hepatitis on liver biopsy 1, 3
The American College of Gastroenterology notes that predominant serum aminotransferase abnormality with globulin, γ-globulin or IgG levels ≥1.5 times normal is characteristic of definite AIH 1, 3
Female sex is a supportive feature that contributes to diagnostic scoring, as stated by the British Society of Gastroenterology 4, 5
The alkaline phosphatase (ALP) to AST (or ALT) ratio is typically <1.5 in AIH, according to the American Association for the Study of Liver Diseases 4, 5

The International Autoimmune Hepatitis Group recommends that the comprehensive scoring system includes parameters such as gender, ALP:AST ratio, serum globulin/IgG levels, autoantibodies, viral markers, drug history, alcohol intake, histology, and other autoimmune diseases 4, 5
The European Association for the Study of the Liver states that pre-treatment scores >15 indicate definite AIH, while scores 10-15 suggest probable AIH 4, 5

The American College of Gastroenterology recommends that patients with moderate or severe AIH, young patients, symptomatic patients, and those with cirrhosis should be offered immunosuppressive treatment due to clear survival benefits 4, 5
The American Association for the Study of Liver Diseases notes that untreated moderate to severe AIH can progress to cirrhosis in 82% of patients within 5 years, with 45% mortality 3
The British Society of Gastroenterology states that treatment may be considered in asymptomatic patients on a trial basis to assess symptom improvement 4, 5