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Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

Authors

  • Maïté Lewin,

    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
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  • Valérie Vilgrain,

    1. Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
    2. Institut National de la santé et de la recherche médicale (National Institute of Health and Medical Research), Denis Diderot University, Paris, France
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  • Violaine Ozenne,

    1. Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
    2. Institut National de la santé et de la recherche médicale (National Institute of Health and Medical Research), Denis Diderot University, Paris, France
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  • Maud Lemoine,

    1. Department of Hepatology, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
    2. Bobigny Paris XIII University, Bobigny, France
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  • Dominique Wendum,

    1. Department of Pathology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
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  • Valérie Paradis,

    1. Department of Pathology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
    2. Institut National de la santé et de la recherche médicale (National Institute of Health and Medical Research), Denis Diderot University, Paris, France
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  • Marianne Ziol,

    1. Department of Pathology, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
    2. Bobigny Paris XIII University, Bobigny, France
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  • Lionel Arrivé,

    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
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  • Michel Beaugrand,

    1. Department of Hepatology, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
    2. Bobigny Paris XIII University, Bobigny, France
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  • Raoul Poupon,

    1. Department of Hepatology, Centre de référence des maladies inflammatoires des voies biliaires, (Reference Center for Inflammatory Biliary Diseases) Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
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  • Dominique Valla,

    1. Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
    2. Institut National de la santé et de la recherche médicale (National Institute of Health and Medical Research), Denis Diderot University, Paris, France
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  • Olivier Chazouillères,

    1. Department of Hepatology, Centre de référence des maladies inflammatoires des voies biliaires, (Reference Center for Inflammatory Biliary Diseases) Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
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  • Christophe Corpechot

    Corresponding author
    1. Department of Hepatology, Centre de référence des maladies inflammatoires des voies biliaires, (Reference Center for Inflammatory Biliary Diseases) Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris VI University, Paris, France
    • Service d'Hépatologie, Centre de référence des maladies inflammatoires des voies biliaires, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
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    • fax: (33)-1-49-28-21-07


Abstract

The development of sclerosing cholangitis (SC) is observed in up to 50% of children followed up for autoimmune hepatitis (AIH). In adults, the prevalence is less known, although a recent study found evidence of SC in 10% of AIH patients using magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to assess prospectively the prevalence of SC in adults with AIH. Fifty-nine consecutive patients with AIH diagnosed according to International Autoimmune Hepatitis Group score (women, 71%; mean age, 48 years; cirrhosis, 23%) underwent both MRCP and percutaneous liver biopsy. Twenty-seven patients with cirrhosis of nonbiliary or non-autoimmune etiology served as controls. Fourteen AIH patients (24%) showed mild MRCP abnormalities of intrahepatic bile ducts (IHBDs). None had abnormal common bile duct or convincing evidence of SC on MRCP or biopsy. A diagnosis of overlapping SC was nevertheless retained in one patient with MRCP abnormalities who subsequently developed symptomatic cholestasis despite corticosteroid therapy. Fibrosis score was the only independent parameter associated with bile duct abnormalities on MRCP (odds ratio 2.4; 95% confidence interval 1.4-4.7) and the percentage of patients with IHBD MRCP abnormalities was not different among F3-F4 AIH patients (n = 24) and cirrhotic controls (46% versus 59%; NS). Conclusion: In this cohort of adult patients with AIH, the prevalence of SC was much lower than previously reported (1.7%). Mild MRCP abnormalities of IHBD were seen in a quarter of patients, but these abnormalities resulted from hepatic fibrosis and not SC. In the absence of cholestatic presentation, MRCP screening does not seem justified in adult-onset AIH. (HEPATOLOGY 2009.)

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