Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH).
audit
autoimmune hepatitis
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
2022
2022
Historique:
received:
25
08
2020
revised:
16
03
2021
accepted:
18
03
2021
entrez:
17
3
2022
pubmed:
18
3
2022
medline:
18
3
2022
Statut:
epublish
Résumé
Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals. Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool. Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3-23) gastroenterologists; including 3 (0-10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18-100) of all consultants managing AIH: in DGH's 92% (20-100) vs 46% (17-100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital. Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
Sections du résumé
Background
UNASSIGNED
Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals.
Methods
UNASSIGNED
Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.
Results
UNASSIGNED
Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3-23) gastroenterologists; including 3 (0-10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18-100) of all consultants managing AIH: in DGH's 92% (20-100) vs 46% (17-100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital.
Conclusion
UNASSIGNED
Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
Identifiants
pubmed: 35295749
doi: 10.1136/flgastro-2020-101661
pii: flgastro-2020-101661
pmc: PMC8862490
doi:
Types de publication
Journal Article
Langues
eng
Pagination
126-132Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Liver Int. 2018 Sep;38(9):1686-1695
pubmed: 29455458
Am J Gastroenterol. 2015 Jul;110(7):993-9
pubmed: 26010310
Lancet. 2020 Jan 18;395(10219):226-239
pubmed: 31791690
Hepatology. 2018 Oct;68(4):1487-1497
pubmed: 29663477
Clin Gastroenterol Hepatol. 2019 Sep;17(10):2068-2075.e2
pubmed: 30625402
Gastroenterology. 2011 Jun;140(7):1980-9
pubmed: 21396370
Aliment Pharmacol Ther. 2018 Nov;48(9):951-960
pubmed: 30226274
Clin Med (Lond). 2012 Apr;12(2):114-8
pubmed: 22586783
Gastroenterol Hepatol. 2004 Apr;27(4):239-43
pubmed: 15056409
Scand J Gastroenterol. 2008;43(10):1232-40
pubmed: 18609163
QJM. 1997 Apr;90(4):289-96
pubmed: 9307764
Gut. 2011 Dec;60(12):1611-29
pubmed: 21757447
J Gastroenterol Hepatol. 2010 Oct;25(10):1681-6
pubmed: 20880179
Hepatology. 2010 Jun;51(6):2193-213
pubmed: 20513004
J Hepatol. 2014 Mar;60(3):612-7
pubmed: 24326217
J Hepatol. 2015 Oct;63(4):971-1004
pubmed: 26341719