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General Liver I
PTU-032 Management of autoimmune hepatitis: a UK-wide survey
  1. H Dhaliwal,
  2. C Facey,
  3. D Gleeson
  1. Liver Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK

Abstract

Introduction Most hepatologists and many gastroenterologists manage patients with autoimmune hepatitis (AIH). There are no data regarding management of AIH in the UK as a whole. We aimed to conduct a survey of UK clinicians' practice in regard to managing AIH.

Methods An anonymised online questionnaire was e-mailed to 952 UK gastroenterology and hepatology consultant physicians, identified via the Directory of Gastroenterology.1 Responses were collected via surveymonkey, an online questionnaire tool. We included only responders who indicated that they managed patients with liver disease. We defined responders as hepatologists if liver disease made up >70% of their workload.

Results 228 (24%) responded, 222 of whom managed patients with liver disease (38 (17%) hepatologists and 184 (83%) gastroenterologists). 26% managed ≤5 patients with AIH, 25% 6–10, 30% 11–25, 10% 26–50 and 8% >50 patients. Half the responders indicated that all gastroenterologists in their hospital managed AIH; the remainder indicated that AIH was managed by hepatologists or gastroenterologists with a “liver” interest. Diagnostic liver biopsy (in absence of serious contraindication) was performed always by 62%, usually by 27% and only if the diagnosis was in doubt by 11%. Hepatologists were more likely than gastroenterologists to perform diagnostic liver biopsy always (82% vs 58%; p=0.02). As routine initial therapy, 80% of respondents used prednisolone+azathioprine (PRED+AZA) combined, 12% used PRED alone and 3% used budesonide+AZA. 65% continued PRED only until serum ALT normalised or for up to 6 months. 20% did so for >12 months and 15% did so until confirmation of histological remission. Gastroenterologists were more likely than hepatologists to continue PRED only until ALT normalised or for up to 6 months (68 vs 50%) and were less likely to do so until confirmation of histological remission (12 vs 29%; p=0.02). 17% of respondents repeated liver biopsy routinely to confirm histological remission, 67% did so in selected cases and 16% never did. 63% routinely used maintenance therapy and 30% did so only after first relapse. Preferred maintenance therapy was AZA monotherapy in 74% and AZA+PRED in 21%. 34% of respondents continued maintenance therapy indefinitely, 59% attempted withdrawal (6% after 2–5 years; 50% after 5–10 years and 3% after 10–20 years) and 7% had a personalised approach. There were no differences between hepatologists and gastroenterologists regarding repeat liver biopsy policy or maintenance therapy.

Conclusion In the UK, there is much variation in the approach to managing AIH, specifically in regard to: role of liver biopsy, initial therapy (particularly duration of steroids) and use of maintenance therapy.

Competing interests None declared.

Reference 1. Directory of Gastroenterology 2011. 5th edn. Mediahuset.

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