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Confirmation of the Diagnosis: Interpreting the Serology

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Book cover Autoimmune Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Serological testing for autoantibodies plays an important role in the diagnosis and classification of autoimmune hepatitis (AIH). Autoantibody testing can also help distinguishing this disease from autoimmune cholestatic diseases, such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) and facilitate diagnosis of overlapping conditions.

This chapter attempts to provide an overview of the autoantibody serology in patients with AIH that will be of value not only to hepatologists but also to those physicians and health care professionals who look after patients with this condition. Before ordering a test, the physician must have a clear indication of the outcome of the test. Worryingly, clinicians tend to rely on the results of autoantibody testing to make, rather to confirm, a diagnosis of AIH. The detection of particular autoantibody reactivities and identification of their antigen specificity may have both diagnostic and prognostic significance. However, their main indications for use are to confirm a diagnosis of AIH in patients with suspected disease or to exclude the diagnosis in patients with uncertain clinical and laboratory findings. Autoantibody test results are also used to subclassify patients known to have AIH into serologically distinct groups (and to monitor disease activity or response to treatment over time under certain circumstances). Hence, detection of AIH-related autoantibodies has assumed an important role in the diagnosis and management of patients with this disease.

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Abbreviations

AIH:

Autoimmune hepatitis

AMA:

Antimitochondrial antibody

ANA:

Antinuclear antibody

ANCA:

Antineutrophil cytoplasmic antibody

ASGPR:

Asialoglycoprotein receptor

c-ANCA:

Cytoplasmic antineutrophil cytoplasmic antibodies

CYP:

Cytochrome

ELISA:

Enzyme-linked immunosorbent assay

HEp:

Human epithelioma (cells)

IAIHG:

International Autoimmune Hepatitis Group

IFL:

Indirect immunofluorescence

IgG:

Immunoglobulin G

F-actin:

Filamentous actin

FTCD:

Formiminotransferase cyclodeaminase

LKM1:

Liver kidney microsomal type 1

LC1:

Liver cytosol type 1

p-ANCA:

Perinuclear antineutrophil cytoplasmic antibodies

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitis

SLA:

Soluble liver antigen

SMA:

Smooth muscle antibody

TBB5:

Tubulin beta B5

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Authors and Affiliations

  1. Liver Immunopathology, Institute of Liver Studies, King’s College Hospital, Denmark Hill, London, UK

    Dimitrios P. Bogdanos

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  1. Dimitrios P. Bogdanos
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Correspondence to Dimitrios P. Bogdanos .

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  1. Toronto Western Hospital Liver Centre, Department of Medicine, University of Toronto, Bathhurst St. 399, Toronto, M5T 2S8, Ontario, Canada

    Gideon M. Hirschfield

  2. Toronto Western Hospital Liver Centre, University of Toronto, Bathhurst St. 399, Toronto, M5T 2S8, Ontario, Canada

    E. Jenny Heathcote

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Bogdanos, D.P. (2012). Confirmation of the Diagnosis: Interpreting the Serology. In: Hirschfield, G., Heathcote, E. (eds) Autoimmune Hepatitis. Clinical Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-60761-569-9_4

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  • DOI: https://doi.org/10.1007/978-1-60761-569-9_4

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