Autoimmune hepatitis is a chronic inflammatory disease of the liver of unknown cause that can affect children and adults. However, it may present as acute or chronic hepatitis in elderly. To corroborate these findings, the current study was conducted to assess various features in older patients with autoimmune hepatitis. The investigators recruited and compared 28 patients diagnosed at age > or =65 years with 84 younger patients.

The results divulged that the incidence of autoimmune hepatitis was comparable at all age decades. The sex ratio of male to female was 1:3 in patients who were > or =65 years in contrast to 1:2 in younger patients. However, presenting symptoms of the elderly patients were similar to those of younger patients and involved general malaise and fatigue (36%), jaundice +/- other symptoms (50%), or ascites (11%). Antinuclear antibodies (ANA) > or = 1/80 were found to be positive in 93%, smooth muscle antibodies (SMA) > 1/40 in 50%, anti-liver kidney microsomes (anti-LKM) were always negative. Histological features revealed acute necrotizing hepatitis in 19%, severe interphase hepatitis in 15%, chronic hepatitis with plasmo-lymphocytic infiltrate in 30%, cirrhosis in 29% (with active inflammation in one-third); whereas biopsy was declined in 11%. Moreover, elderly patients exhibited a positive respond to low doses of methylprednisolone (< or =8 mg) and azathioprine (1 mg/kg). This administration of low dosages of drugs significantly removed adverse effects such as infections, which are associated with higher dosages.

To conclude, autoimmune hepatitis should be identified appropriately in the elderly patients with both acute and chronic hepatitis. Additionally, steroid therapy administered to these patients should be patient specific with low dosages.

Source: Verslype C, George C, Buchel E, Nevens F, van Steenbergen W, Fevery J. Diagnosis and treatment of autoimmune hepatitis at age 65 and older. Aliment Pharmacol Ther. 2005 Mar 15;21(6):695-9.