Autoimmune hepatitis: Clinical manifestations and diagnostic criteria

In 1998, the International Autoimmune Hepatitis Group a panel of 40 hepatol ogists and heyatopathologists from ii countries who have a particular inter est in autoimmune hepatitis (AIH) - undertook a review, in light of subsequ ent experience, of the descriptive criteria and diagnostic scoring system t hat it had proposed in 1993 for the diagnosis of AIH. This review (publishe d in 1999) noted that the original descriptive criteria appeared to be quit e robust and required only relatively minor modifications to bring them up to date with developments and experience in diagnostic modalities for liver disease in general. Analysis of published data on the application of the : original criteria in nearly 1000 patients revealed that the diagnostic sco ring system had an overall diagnostic accuracy of 89.8%, with a sensitivity of 98.0%. Specificity for excluding definite AIH in patients with chronic viral hepatitis and circulating autoantibodies or patients with overlapping cholestatic syndromes was 98% to 100%, but specificity for excluding proba ble AIH in these disorders ranged from only 60% to 80%. Modifications, incl uding adjustments to the weightings against biochemical and histological ch olestatic features, have been made to the scoring system to improve its spe cificity.