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Editor,—We were interested to read Professor James’ comments on autoimmune hepatitis (AIH) in his review of parenchymal liver disease in the elderly (Gut1997;41:430–2). He described an unpublished series of patients with AIH, 20% of whom were over 65 years of age1at presentation. We recently published an 11-year follow up of patients with type I AIH from an unselected population in South Wales.2 Forty one patients were identified according to the AIH group criteria. The median age was 62 years and 23 (56%) patients were over 60 years of age at presentation; the usual presentation was an acute icteric hepatitis. Response to immunosuppression in the over-60’s was gratifying and prompt and the five year survival rate compared favourably with that of our series as a whole. Our experience is similar to that of the Newcastle group, and it now seems clear that AIH should no longer be regarded primarily as a disease of the young. Indeed, our unselected series suggests that AIH is primarily a disease of the elderly. The diagnosis should be considered in any patient presenting with acute icteric hepatitis whatever his or her age.
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