Diagnostic Approach to Autoimmune Hepatitis

Initial Evaluation and Referral

Primary care physicians should perform initial screening tests for suspected autoimmune hepatitis (AIH), including complete liver biochemistry panel and serum immunoglobulin G (IgG) levels, while reserving liver biopsies and specialized immunological testing for specialist care settings, as recommended by the European Association for the Study of the Liver 1, 2
Patients with elevated liver enzymes and positive autoantibodies should be referred to specialist care for further evaluation and management, according to the American Association for the Study of Liver Diseases 1, 5
The American Gastroenterological Association recommends that patients with suspected AIH based on initial screening tests should undergo comprehensive autoantibody panel and histological assessment in specialist care settings 5, 3

A comprehensive autoantibody panel, including quantitative titers of ANA, SMA, anti-LKM1, anti-SLA, and anti-LC1 antibodies, should be performed in specialist care settings to aid in the diagnosis of AIH, as suggested by the European Association for the Study of the Liver 1, 2
Liver biopsy is essential for definitive diagnosis and assessment of disease severity, and should be performed in specialist care settings, according to the American Association for the Study of Liver Diseases 1, 3
The International Autoimmune Hepatitis Group (IAIHG) scoring system should be applied to aid in the diagnosis of AIH, as recommended by the European Association for the Study of the Liver 5, 7

The American Association for the Study of Liver Diseases recommends that immunosuppressive therapy should be initiated in specialist care settings, and that patients should be monitored regularly for treatment response and medication side effects 1, 8
The European Association for the Study of the Liver suggests that liver transplantation evaluation should be considered when indicated, and that patients with AIH require lifelong monitoring and supervision by a hepatologist or gastroenterologist 7, 8