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Overlap and other autoimmune phenomena in pediatric chronic hepatic disease
Patients with chronic liver disease can present serological immune associations or a real overlap syndrome. The hepatic overlap syndrome includes biochemical and histological features either for two autoimmune hepatic diseases or for one autoimmune hepatitis and another chronic hepatic disease (chronic viral hepatitis B or C, Wilson’s disease, fatty liver disease). In the absence of appropriate treatment, the natural course of autoimmune hepatitis and overlap syndromes is towards cirrhosis and liver failure. The diagnostic criteria, prognostic scores and predictive factors for overlap syndromes are not yet established. The serological immune reactions are also found in liver disease other than autoimmune hepatitis. In chronic viral hepatitis C different types of immunological manifestations are oftenly associated. In non-alcoholic fatty liver disease the high prevalence of self-antibodies indicates the presence of an autoimmune response; on the other hand these antibodies can help predict the severity of the disease. The medical therapy of either the autoimmune reaction or the underlying hepatic disease should use an individualized algorithm regarding drug associations, dosing and duration of treatment.
Key words: hepatitis, overlap syndrome