Diagnose en behandeling van auto-immune hepatitis.

Autoimmune hepatitis (AIH) is a progressive, chronic form of hepatitis of unknown cause that occurs in people of all ages. The diagnosis is based on characteristic clinical and biochemical abnormalities, absence of other causes of hepatitis and histopathological characteristics. The variety of symptoms that AIH patients may have and the importance of considering the disease is illustrated in three case studies. The first was a 22-year-old woman with fulminant hepatitis and jaundice. Corticosteroid and azathioprine treatment resulted in prolonged remission. The second patient, a 48-year-old woman, had hepatocellular carcinoma in a cirrhotic liver, based on AIH. Radiofrequency ablation was planned, after which the patient would be put on the waiting list for transplantation. The third patient was an 81-year-old man with impaired liver function and cirrhosis. His treatment was the same as in the first patient and resulted in remission as well. No curative therapy for AIH is yet available, but appropriate management of the disease can prolong survival, improve the quality of life, and avoid the need for liver transplantation

High prevalence of apolipoprotein B dyslipoproteinemias in non-alcoholic fatty liver disease:The lifelines cohort study

Objective. Cardiovascular disease (CVD) is a major adverse consequence of non-alcoholic fatty liver disease (NAFLD). The association of NAFLD with various apolipoprotein B (apoB) dyslipoproteinemias is unclear. We determined the prevalence of specific apoB dyslipoproteinemias in subjects with suspected NAFLD. Methods. This study was conducted among 22,865 fasting adults living in the northern part of the Netherlands (Lifelines Cohort Study). Six apoB dyslipoproteinemias were defined using an algorithm derived from apoB, total cholesterol and triglycerides. NAFLD was defined as Fatty Liver Index (FLI) >= 60. Advanced hepatic fibrosis was defined as NAFLD fibrosis score (NFS) >= 0.676. Results. 4790 participants (20.9%) had an FLI >= 60. NAFLD subjects were older, more likely to be men, more obese and more often had diabetes and metabolic syndrome (P <0.001 for each). Among NAFLD subjects, any apoB dyslipoproteinemia was present in 61.5% vs. 16.5% in subjects without NAFLD (P <0.001). Elevated chylomicrons were not observed in NAFLD. In univariate analysis, NAFLD was associated with a higher prevalence of each apoB dyslipoproteinemia vs. subjects with an FLI <60 (P <0.001), except for low density lipoprotein (LDL) dyslipoproteinemia. Additionally, each apoB dyslipoproteinemia was independently associated with NAFLD in age- and sex-adjusted logistic regression analysis, including the apoB dyslipoproteinemias together (P <0.001). The prevalence of apoB dyslipoproteinemias was not altered in subjects with NFS >= 0.676. Conclusions. NAFLD rather than advanced hepatic fibrosis is independently associated with increased prevalence of chylomicrons + very low-density lipoproteins (VLDL) remnants, VLDL, LDL and VLDL + LDL dyslipoproteinemias. ApoB dyslipoproteinemias may contribute to increased CVD risk associated with NAFLD. (C) 2017 Elsevier Inc. All rights reserved

Free triiodothyronine as determinant of non-alcoholic fatty liver disease in euthyroid subjects: The lifelines cohort study

Background: Non-alcoholic fatty live disease (NAFLD) is becoming the leading cause of chronic liver disease in de Western world. The liver plays a crucial role in the metabolism of cholesterol and triglycerides and thyroid hormones interact on hepatic lipid homeostasis. Given the importance of variations in thyroid function within the euthyroid range for a considerable number of health issues, including (subclinical) atherosclerosis and biochemical markers of increased cardiovascular risk, it is relevant to examine the relationship of NAFLD with thyroid function parameters in an euthyroid population. Methods: The study was conducted in the LifeLines Cohort Study (N=167,729), a population-based cohort study examining the health and health-related behaviors of participants living in the North of The Netherlands. Only euthyroid subjects (TSH 0.5-4.0 mU/L, FT4 11-19.5 pmol/L and FT3 4.4-6.7 pmol/L) older than 18 years were included. Exclusion criteria were participants with missing data, excessive alcohol use, known hepatitis or cirrhosis, liver functions ≥ three times the upper limit, current cancer, non-white ancestry, previous or current use of thyroid medication and current use of lipid and glucose lowering medication. A priori defined liver biochemistry, thyroid function parameters and metabolic syndrome (MetS) were studied. NAFLD was defined by using the validated Fatty Liver Index (FLI); FLI ≥60 was categorized as NAFLD. A

Higher free triiodothyronine is associated with non-alcoholic fatty liver disease in euthyroid subjects:The Lifelines Cohort Study

Objective. Overt hypothyroidism confers an increased risk of non-alcoholic fatty liver disease (NAFLD). The liver plays a crucial role in the metabolism of cholesterol and triglycerides; thyroid hormones interact on hepatic lipid homeostasis. Thyroid function within the euthyroid range affects a number of health issues, including atherosclerosis development and biochemical markers of increased cardiovascular risk. However, the association of thyroid hormones with NAFLD in euthyroid subjects has not been unequivocally established. We therefore determined associations of thyroid hormone parameters with NAFLD among euthyroid subjects. Methods. The study was conducted in the Lifelines Cohort Study, a population-based cohort study of participants living in the North of the Netherlands. Only euthyroid subjects (thyroid-stimulating hormone (TSH) 0.5-4.0 mU/L, free thyroxine (FT4) 11-19.5 pmol/L and free triiodothyronine (FT3) 4.4-6.7 pmol/L) older than 18 years were included. Exclusion criteria were participants with excessive alcohol use, known hepatitis or cirrhosis, liver functions > three times the upper limit, current cancer, non-white ancestry, previous or current use of thyroid medication and current use of lipid or glucose lowering medication. A priori defined liver biochemistry, thyroid function parameters and metabolic syndrome (MetS) were studied. NAFLD was defined by using the validated Fatty Liver Index (FLI); FLI > 60 was categorized as NAFLD. A P <0.01 was considered significant. Results. FLI >= 60 was found in 4274 (21.1%) of 20,289 individuals (62.1% male, median age 46 years) with increased prevalence of MetS (P <0.0001). In age- and sex-adjusted analysis FLI >= 60 was independently associated with a higher FT3 (OR 1.34, 95% CI 1.29-1.39, per SD increment, P <0.0001) and a lower FT4 (OR 0.73, 95% CI 0.70-0.75, P <0.0001) but not by TSH. The strongest association was found for the FT3/FT4 ratio (OR 1.44, 95% CI 1.39-1.49, P <0.0001). These associations remained similar after additional adjustment for the presence of MetS. In subjects with enlarged waist circumference, TSH and FT4 were lower while FT3 was higher, resulting in an increased FT3/FT4 ratio (P <0.0001). Conclusions. Euthyroid subjects with suspected NAFLD are characterized by higher FT3, lower FT4 and higher FT3/FT4 ratio, probably consequent to central obesity. (C) 2016 Elsevier Inc. All rights reserved

Incidence and prevalence of primary biliary cholangitis in the Netherlands – A nationwide cohort study

Background &amp; Aims: Although primary biliary cholangitis (PBC) is considered a rare disorder, accurate determination of its incidence and prevalence remains challenging due to limited comprehensive population-based registries. We aimed to assess the incidence and prevalence of PBC in the Netherlands over time through the nationwide Dutch PBC Cohort Study (DPCS). Methods: DPCS retrospectively included every identifiable patient with PBC in the Netherlands from 1990 onwards in all 71 Dutch hospitals. Incidence and prevalence were assessed between 2008-2018 by Poisson regression between sex and age groups over time. Results: On the 1st of January 2008, there were 1,458 patients with PBC in the Netherlands. Between 2008-2018, 2,187 individuals were newly diagnosed, 46 were transplanted and 468 died. The yearly incidence of PBC in 2008 was 1.38, increasing to 1.74 per 100,000 persons in 2018. When compared to those aged <45 years, females aged 45-64 years (adjusted incidence rate ratio 4.21, 95% CI 3.76-4.71, p <0.001) and males ≥65 years (adjusted incidence rate ratio 14.41, 95% CI 9.62-21.60, p <0.001) were at the highest risk of being diagnosed with PBC. The male-to-female ratio of patients newly diagnosed with PBC during the study period was 1:14 in those <45 years, 1:10 in patients aged 45-64 years, and 1:4 in those ≥65 years. Point prevalence increased from 11.9 in 2008 to 21.5 per 100,000 persons in 2018. Average annual percent change in this time period was 5.94% (95% CI 5.77-6.15, p <0.05), and was the highest among the population aged ≥65 years (5.69%, 95% CI 5.32-6.36, p <0.001). Conclusions: In this nationwide cohort study, we observed an increase in both the incidence and prevalence of PBC in the Netherlands over the past decade, with marked age and sex differences. Impact and implications:: This nationwide Dutch primary biliary cholangitis (PBC) Cohort Study, including all hospitals in the Netherlands, showed that the incidence and prevalence of PBC have increased over the last decade. The age-dependent PBC incidence rate differed for males (highest risk ≥65 years) and females (highest risk between 45 and 65 years), which may be related to a difference in the timing of exposure to environmental triggers of PBC. The largest increase in PBC prevalence over time was observed in the population aged ≥65 years, which may have implications for the use of second-line therapies. These results therefore indicate that further studies are needed to elaborate on the advantages and disadvantages of add-on therapies in the elderly population